| NPI | 1902250616 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TONIA SMITH Administrator 520-254-2296 |
| Organization Subpart ? | No |
| Primary Taxonomy | 310500000X Intermediate Care Facility, Mental Illness (Licence: AZ BH4888) |
| Enumeration Date | 2016-04-19 |
| Last Update Date | 2016-04-19 |