| NPI | 1881460913 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ALEJANDRA G VILCHIS Credentialing Provider Data Manager 480-977-1438 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM2800X Clinic/Center Methadone |
| Additional Taxonomies | 261QM0801X Clinic/Center Mental Health (Including Community Mental Health Center) |
| 261QR0405X Clinic/Center Rehabilitation, Substance Use Disorder | |
| 101YA0400X Counselor Addiction (Substance Use Disorder) | |
| 251S00000X Community/Behavioral Health | |
| Enumeration Date | 2023-11-29 |
| Last Update Date | 2024-02-10 |