| NPI | 1083177315 |
|---|---|
| Other Name | 1444 N. 23RD ST |
| Entity Type | Organization |
| Authorized Contact | CHRISTOPHER BRANDON BERGQUIST CFO 970-256-8603 |
| Organization Subpart ? | No |
| Primary Taxonomy | 320900000X Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities |
| Enumeration Date | 2019-04-12 |
| Last Update Date | 2021-08-30 |