| NPI | 1790179919 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CLARISSE YOLLANDE KAMGAING Administrator 602-400-7764 |
| Organization Subpart ? | No |
| Primary Taxonomy | 320800000X Community Based Residential Treatment Facility, Mental Illness (Licence: AZ BH4597) |
| Enumeration Date | 2015-03-25 |
| Last Update Date | 2015-03-25 |