| NPI | 1790114759 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TIMOTHY JORDAN DAVIS Owner 602-451-5263 |
| Organization Subpart ? | No |
| Primary Taxonomy | 311ZA0620X Custodial Care Facility, Adult Care Home (Licence: AZ AL8928H) |
| Enumeration Date | 2013-11-10 |
| Last Update Date | 2013-11-10 |