| NPI | 1962896738 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MICHAEL KERRY VAN GUILDER Executive Director 928-783-6069 |
| Organization Subpart ? | No |
| Primary Taxonomy | 320800000X Community Based Residential Treatment Facility, Mental Illness (Licence: AZ BH4508) |
| Enumeration Date | 2015-03-19 |
| Last Update Date | 2016-04-06 |