| NPI | 1710377650 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | THEODORE MICHAEL CEO 928-493-4373 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QR0405X Clinic/Center, Rehabilitation, Substance Use Disorder (Licence: AZ OTC6815) |
| Enumeration Date | 2015-01-30 |
| Last Update Date | 2016-03-14 |