| NPI | 1093163800 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LATA RAMACHANDRAN Executive Director 970-298-2235 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QF0400X Clinic/Center, Federally Qualified Health Center (FQHC) (Licence: CO 18U295) |
| Additional Taxonomies | 261QD0000X Clinic/Center, Dental |
| Enumeration Date | 2016-06-02 |
| Last Update Date | 2020-09-21 |