| NPI | 1972820371 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LATONYA DENISE JACKSON Owner/Administrator 480-628-4614 |
| Organization Subpart ? | No |
| Primary Taxonomy | 320600000X Residential Treatment Facility, Intellectual and/or Developmental Disabilities (Licence: AZ bh3556) |
| Enumeration Date | 2010-04-23 |
| Last Update Date | 2010-09-17 |