| NPI | 1245938257 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | THERESA MARIE SANDOVAL Executive Director 719-334-3123 |
| Organization Subpart ? | No |
| Primary Taxonomy | 320900000X Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities |
| Additional Taxonomies | 347E00000X Transportation Broker |
| Enumeration Date | 2023-02-20 |
| Last Update Date | 2023-03-13 |