| NPI | 1932420403 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | FRED COGBURN Chief Operating Officer 928-376-0220 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 251S00000X Community/Behavioral Health (Licence: AZ BH-3609) |
| Enumeration Date | 2010-06-18 |
| Last Update Date | 2010-06-18 |