| NPI | 1073461497 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BANAFSHE' KING Cred & Enrollment Specialist 719-287-2637 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QR0405X Clinic/Center, Rehabilitation, Substance Use Disorder |
| Enumeration Date | 2026-03-20 |
| Last Update Date | 2026-03-20 |