| NPI | 1790064152 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CLARISSE YOLLANDE KUISSU Administrator 602-400-7764 |
| Organization Subpart ? | No |
| Primary Taxonomy | 320800000X Community Based Residential Treatment Facility, Mental Illness (Licence: AZ BH3876) |
| Additional Taxonomies | 323P00000X Psychiatric Residential Treatment Facility (Licence: AZ BH3876) |
| Enumeration Date | 2011-08-16 |
| Last Update Date | 2011-08-16 |