| NPI | 1053909192 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CAROL A ARAGON Credentialing Specialist 719-383-5408 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QR0405X Clinic/Center, Rehabilitation, Substance Use Disorder |
| Additional Taxonomies | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) |
| Enumeration Date | 2021-01-05 |
| Last Update Date | 2021-04-01 |