| NPI | 1841968625 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CASSANDRA FORTSON Managing Member 480-868-8697 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X |
| Additional Taxonomies | 261QR0405X Clinic/Center, Rehabilitation, Substance Use Disorder |
| Enumeration Date | 2021-09-05 |
| Last Update Date | 2023-09-21 |