| NPI | 1922396639 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CHRIS COHN Owner 602-478-3210 |
| Organization Subpart ? | No |
| Primary Taxonomy | 324500000X Substance Abuse Rehabilitation Facility (Licence: AZ OTC7795) |
| Additional Taxonomies | 251S00000X (Licence: AZ OTC7795) |
| Enumeration Date | 2011-07-14 |
| Last Update Date | 2022-07-21 |