| NPI | 1861701146 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ROBERT NGONGHOPONGHO FORLEMU Administrator/Program Director 520-270-7061 |
| Organization Subpart ? | No |
| Primary Taxonomy | 320800000X Community Based Residential Treatment Facility, Mental Illness (Licence: AZ BH-3897) |
| Enumeration Date | 2010-10-04 |
| Last Update Date | 2011-08-16 |