| NPI | 1487935144 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BRADLEY JAMES RUSOVICK Director 719-334-1010 |
| Organization Subpart ? | No |
| Primary Taxonomy | 324500000X Substance Abuse Rehabilitation Facility (Licence: CO 139100) |
| Enumeration Date | 2011-09-07 |
| Last Update Date | 2011-09-07 |