| NPI | 1982016283 |
|---|---|
| Doing Business As | GRACE HOUSE-MCKINNIE AVENUE |
| Entity Type | Organization |
| Authorized Contact | MATT LUCHINI Account Manager 928-533-4220 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QR0405X Clinic/Center, Rehabilitation, Substance Use Disorder |
| Enumeration Date | 2014-05-21 |
| Last Update Date | 2014-06-20 |