| NPI | 1871095232 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | IRENE FON Md 623-748-9379 |
| Organization Subpart ? | No |
| Primary Taxonomy | 320800000X Community Based Residential Treatment Facility, Mental Illness |
| Enumeration Date | 2018-03-01 |
| Last Update Date | 2018-03-01 |