| NPI | 1780329524 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | STEVEN FULLER Owner 480-286-0568 |
| Organization Subpart ? | No |
| Primary Taxonomy | 320600000X Residential Treatment Facility, Intellectual and/or Developmental Disabilities |
| Additional Taxonomies | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) |
| Enumeration Date | 2022-05-04 |
| Last Update Date | 2022-05-04 |