| NPI | 1710369483 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARK LAWRENCE Manager 602-625-5808 |
| Organization Subpart ? | No |
| Primary Taxonomy | 324500000X Substance Abuse Rehabilitation Facility (Licence: AZ BH-4102) |
| Additional Taxonomies | 324500000X Substance Abuse Rehabilitation Facility (Licence: AZ BH-4103) |
| 324500000X Substance Abuse Rehabilitation Facility (Licence: AZ BH-4084) | |
| 324500000X Substance Abuse Rehabilitation Facility (Licence: AZ BH-4101) | |
| Enumeration Date | 2015-06-18 |
| Last Update Date | 2015-06-18 |