| NPI | 1427506963 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ETHAN SELVIG Owner/Operator 303-960-4822 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health (Licence: CO 1686) |
| Enumeration Date | 2016-09-13 |
| Last Update Date | 2016-09-13 |