| NPI | 1124757745 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MIKE EDWARD JORDAN Owner 719-251-4604 |
| Organization Subpart ? | No |
| Primary Taxonomy | 320900000X Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities |
| Enumeration Date | 2022-06-08 |
| Last Update Date | 2022-06-08 |