| NPI | 1780405043 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JIMMY EVANS Manager 602-524-5521 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X |
| Additional Taxonomies | 261QR0401X Clinic/Center, Rehabilitation, Comprehensive Outpatient Rehabilitation Facility (CORF) |
| Enumeration Date | 2024-10-21 |
| Last Update Date | 2024-10-21 |