| NPI | 1528822343 |
|---|---|
| Doing Business As | CORDILLERAS HEALTH & HEALING PONDEROSA HOUSE |
| Entity Type | Organization |
| Authorized Contact | MICHELLE SMITH Executive Director Ar Reimb. 209-955-2364 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 310500000X Intermediate Care Facility, Mental Illness |
| Enumeration Date | 2024-02-12 |
| Last Update Date | 2024-02-12 |