| NPI | 1295157592 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JILL CHRISTINA KRUSH Sole Proprietor 605-430-0954 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health (Licence: CO 11757) |
| Enumeration Date | 2014-01-06 |
| Last Update Date | 2014-01-06 |