| NPI | 1871026674 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | REGINA SHAKESPEARE Billing Compliance Officer 928-554-5633 |
| Organization Subpart ? | No |
| Primary Taxonomy | 324500000X Substance Abuse Rehabilitation Facility |
| Additional Taxonomies | 364SP0809X Clinical Nurse Specialist, Psych/Mental Health, Adult (Licence: AZ OTC7755) |
| 364SP0809X Clinical Nurse Specialist, Psych/Mental Health, Adult | |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: AZ OTC7755) | |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) | |
| 251S00000X (Licence: AZ OTC8541) | |
| Enumeration Date | 2017-04-07 |
| Last Update Date | 2020-01-31 |