| NPI | 1639834336 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | WILLIAM BRADFORD Director 719-565-8829 |
| Organization Subpart ? | No |
| Primary Taxonomy | 320900000X Community Based Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities |
| Enumeration Date | 2021-11-08 |
| Last Update Date | 2021-11-08 |