| NPI | 1376178517 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | VENESSA ELLINGTON ALSTON Owner 719-434-2768 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) |
| Additional Taxonomies | 3245S0500X Substance Abuse Rehabilitation Facility, Substance Abuse Treatment, Children |
| Enumeration Date | 2020-03-09 |
| Last Update Date | 2022-02-12 |