| NPI | 1013210947 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BANAFSHE' KING Credentialing & Enrollment Spec 719-419-7959 |
| Organization Subpart ? | No |
| Primary Taxonomy | 324500000X Substance Abuse Rehabilitation Facility |
| Additional Taxonomies | 251B00000X Case Management |
| 251S00000X | |
| 261QM2800X Clinic/Center, Methadone Clinic | |
| 261QR0405X Clinic/Center, Rehabilitation, Substance Use Disorder | |
| Enumeration Date | 2010-12-15 |
| Last Update Date | 2025-01-30 |