NPI | 1013210947 |
---|---|
Entity Type | Organization |
Authorized Contact | BANAFSHE' KING Credentialing & Enrollment Spec 719-419-7959 |
Organization Subpart ? | No |
Primary Taxonomy | 261QR0405X Clinic/Center Rehabilitation, Substance Use Disorder |
Enumeration Date | 2010-12-15 |
Last Update Date | 2023-12-01 |