| NPI | 1235504184 |
|---|---|
| Former Legal Business Name | EXTREME SPORTS CAMP |
| Entity Type | Organization |
| Authorized Contact | MAUREEN MULLER Business Manager 970-927-3143 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health (Licence: CO 10X839) |
| Enumeration Date | 2015-12-03 |
| Last Update Date | 2017-02-21 |