| NPI | 1295287092 |
|---|---|
| Other Name | MESA HOME |
| Entity Type | Organization |
| Authorized Contact | JONI KAY WOLFE Exexutive Director 719-253-0095 |
| Organization Subpart ? | No |
| Primary Taxonomy | 320900000X Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities (Licence: CO 05J549) |
| Enumeration Date | 2016-10-27 |
| Last Update Date | 2016-10-27 |