| NPI | 1184815680 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 323P00000X Psychiatric Residential Treatment Facility (Licence: CO LPC3114) |
| Additional Taxonomies | 324500000X Substance Abuse Rehabilitation Facility (Licence: CO CACIII 6152) |
| Enumeration Date | 2007-08-08 |
| Last Update Date | 2007-08-08 |