| NPI | 1639934169 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SCOTT WILLIAM LISTER COO 970-987-2583 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QR0405X Clinic/Center, Rehabilitation, Substance Use Disorder |
| Additional Taxonomies | 261QM0850X Clinic/Center, Adult Mental Health |
| Enumeration Date | 2024-02-14 |
| Last Update Date | 2024-02-14 |