| NPI | 1710556808 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ESTIL WALLACE CEO 602-544-6832 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 324500000X Substance Abuse Rehabilitation Facility |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health |
| Enumeration Date | 2021-06-22 |
| Last Update Date | 2025-05-27 |