| NPI | 1700419488 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ROY GULTOM Co Owner 720-579-6204 |
| Organization Subpart ? | No |
| Primary Taxonomy | 320600000X Residential Treatment Facility, Intellectual and/or Developmental Disabilities |
| Additional Taxonomies | 385H00000X Respite Care |
| Enumeration Date | 2020-02-20 |
| Last Update Date | 2020-12-29 |