| NPI | 1730681685 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JESSICA VELARDE Administrative Analyst 520-471-2206 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health (Licence: AZ OTC-8835) |
| Additional Taxonomies | 251S00000X Community/Behavioral Health (Licence: AZ PENDING) |
| Enumeration Date | 2018-03-07 |
| Last Update Date | 2021-01-14 |