| NPI | 1871172536 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | WELLENGTEN JENKINS Member Manager 602-421-6667 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 320800000X Community Based Residential Treatment Facility, Mental Illness |
| Additional Taxonomies | 251S00000X |
| Enumeration Date | 2021-04-07 |
| Last Update Date | 2021-04-07 |