NPI | 1366064149 |
---|---|
Entity Type | Organization |
Authorized Contact | BANAFSHE' KING Credentialing & Enrollment Spec 719-419-7959 |
Organization Subpart ? | No |
Primary Taxonomy | 324500000X Substance Abuse Rehabilitation Facility |
Additional Taxonomies | 261QM2800X Clinic/Center, Methadone Clinic |
261QR0405X Clinic/Center, Rehabilitation, Substance Use Disorder | |
Enumeration Date | 2020-05-14 |
Last Update Date | 2025-01-30 |