| NPI | 1619272754 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BANAFSHE' KING Credentialing & Enrollment Spec 719-419-7959 |
| Organization Subpart ? | No |
| Primary Taxonomy | 324500000X Substance Abuse Rehabilitation Facility (Licence: CO 6880) |
| Enumeration Date | 2011-01-21 |
| Last Update Date | 2023-12-01 |