| NPI | 1043762859 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | COREY CANDELARIA Owner/Provider 303-222-4451 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM2800X Clinic/Center, Methadone Clinic |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) |
| 363AM0700X Physician Assistant, Medical | |
| Enumeration Date | 2016-10-27 |
| Last Update Date | 2016-12-05 |