| NPI | 1952717654 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | IFFA DIRIBA WOLKABA Owner 602-330-2203 |
| Organization Subpart ? | No |
| Primary Taxonomy | 320900000X Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities (Licence: AZ AL9017H) |
| Enumeration Date | 2014-07-02 |
| Last Update Date | 2014-07-02 |