| NPI | 1639624190 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | THERESA VERA Owner/Partner 719-473-6612 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health (Licence: CO 20111511620) |
| Enumeration Date | 2016-08-24 |
| Last Update Date | 2018-08-14 |