| NPI | 1174817605 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TIMOTHY EUGENE KELLEY Owner 719-469-0799 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health (Licence: CO 3479) |
| Enumeration Date | 2011-06-01 |
| Last Update Date | 2011-09-15 |