| NPI | 1265565824 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MANDY JO KAISNER CEO 719-275-2351 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 251S00000X (Licence: CO 1306) |
| Additional Taxonomies | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) (Licence: CO 1668-00) |
| Enumeration Date | 2007-03-13 |
| Last Update Date | 2024-05-08 |