| NPI | 1912349440 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RUDY VEGA CEO 602-298-2540 |
| Organization Subpart ? | No |
| Primary Taxonomy | 320800000X Community Based Residential Treatment Facility, Mental Illness (Licence: AZ BH4156) |
| Additional Taxonomies | 320900000X Community Based Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities (Licence: AZ BH4156) |
| Enumeration Date | 2013-07-25 |
| Last Update Date | 2022-11-07 |