| NPI | 1518407808 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JONNA KAY MCCLURE Owner 719-564-0163 |
| Organization Subpart ? | No |
| Primary Taxonomy | 320900000X Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities |
| Additional Taxonomies | 251C00000X (Licence: CO 02570262) |
| Enumeration Date | 2017-03-06 |
| Last Update Date | 2021-11-05 |