| NPI | 1669888764 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | NATHANIEL J MOORE President 720-560-1006 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP2300X Clinic/Center, Primary Care (Licence: CO 35543) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: CO 7693) |
| Enumeration Date | 2014-07-09 |
| Last Update Date | 2018-03-17 |