| NPI | 1083410187 |
|---|---|
| Doing Business As | HOMEWARD BOUND NORTH AVE |
| Entity Type | Organization |
| Authorized Contact | JENNIFER RUDNIK Credentialing Manager 719-423-1341 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 261QP2300X Clinic/Center, Primary Care |
| Enumeration Date | 2025-02-20 |
| Last Update Date | 2025-02-27 |