| NPI | 1669972105 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DONITA E DAVENPORT Case Manager 970-545-1641 |
| Organization Subpart ? | No |
| Primary Taxonomy | 324500000X Substance Abuse Rehabilitation Facility |
| Enumeration Date | 2018-02-20 |
| Last Update Date | 2018-02-20 |