| NPI | 1790350056 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | IYONNA SMITH Owner 602-384-4845 |
| Organization Subpart ? | No |
| Primary Taxonomy | 320800000X Community Based Residential Treatment Facility, Mental Illness |
| Additional Taxonomies | 320700000X Residential Treatment Facility, Physical Disabilities |
| 323P00000X Psychiatric Residential Treatment Facility | |
| 324500000X Substance Abuse Rehabilitation Facility | |
| 3245S0500X Substance Abuse Rehabilitation Facility Substance Abuse Treatment, Children | |
| 385HR2050X Respite Care Respite Care Camp | |
| 385HR2055X Respite Care Respite Care, Mental Illness, Child | |
| 385HR2060X Respite Care Respite Care, Mental Retardation and/or Developmental Disabilities | |
| 385HR2065X Respite Care Respite Care, Physical Disabilities, Child | |
| Enumeration Date | 2021-05-20 |
| Last Update Date | 2021-05-20 |