| NPI | 1700889151 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | GENE SOBCZAK CEO 719-336-0261 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QF0400X Clinic/Center, Federally Qualified Health Center (FQHC) |
| Additional Taxonomies | 261QC1500X Clinic/Center, Community Health (Licence: CO 0610) |
| Enumeration Date | 2005-05-31 |
| Last Update Date | 2024-09-04 |