| NPI | 1972149078 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | VICTOR NKEM Owner 520-302-6217 |
| Organization Subpart ? | No |
| Primary Taxonomy | 320800000X Community Based Residential Treatment Facility, Mental Illness |
| Additional Taxonomies | 320900000X Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities |
| 324500000X Substance Abuse Rehabilitation Facility | |
| Enumeration Date | 2019-11-23 |
| Last Update Date | 2021-01-08 |