| NPI | 1861083859 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JONATHAN EARL LONG Owner/Adminstrator 602-427-8959 |
| Organization Subpart ? | No |
| Primary Taxonomy | 320800000X Community Based Residential Treatment Facility, Mental Illness |
| Enumeration Date | 2021-02-01 |
| Last Update Date | 2021-08-10 |