| NPI | 1487368601 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MACHANDOQUE KOTILO Owner 720-327-8315 |
| Organization Subpart ? | No |
| Primary Taxonomy | 320900000X Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities |
| Additional Taxonomies | 251C00000X |
| Enumeration Date | 2023-01-11 |
| Last Update Date | 2023-01-11 |