| NPI | 1801547468 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | AARON DAVID HALLSTROM Owner 480-360-2172 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health |
| Additional Taxonomies | 261QM0801X |
| Enumeration Date | 2022-01-14 |
| Last Update Date | 2022-04-01 |