NPI | 1386266286 |
---|---|
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 | 2020-05-13 |
Last Update Date | 2025-01-30 |