| NPI | 1720650583 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ANTHONY VINCENT OLORUNSOLA Statutory Officer 623-806-6864 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 323P00000X Psychiatric Residential Treatment Facility |
| Enumeration Date | 2021-07-12 |
| Last Update Date | 2021-07-12 |