| NPI | 1710526504 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JANEA BAKER Business Office Manager 970-515-6400 |
| Organization Subpart ? | No |
| Primary Taxonomy | 3245S0500X Substance Abuse Rehabilitation Facility, Substance Abuse Treatment, Children |
| Additional Taxonomies | 322D00000X Residential Treatment Facility, Emotionally Disturbed Children |
| Enumeration Date | 2019-12-27 |
| Last Update Date | 2019-12-27 |