| NPI | 1821796103 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CHARLES JACKSON Cco 602-562-8047 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QR0405X Clinic/Center, Rehabilitation, Substance Use Disorder |
| Additional Taxonomies | 101Y00000X Counselor |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) | |
| 207QA0401X Family Medicine, Addiction Medicine | |
| 324500000X Substance Abuse Rehabilitation Facility | |
| Enumeration Date | 2023-02-16 |
| Last Update Date | 2023-08-04 |