| NPI | 1356963136 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BANAFSHE' KING Credentialing & Enrollment Spec 719-419-7959 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM2800X Clinic/Center, Methadone Clinic |
| Additional Taxonomies | 261QM1300X Clinic/Center, Multi-Specialty |
| Enumeration Date | 2020-05-14 |
| Last Update Date | 2025-07-02 |