| NPI | 1720530835 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | INNAEL TODD MIRANDA Owner 303-518-9963 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health (Licence: CO ACC-7097) |
| Enumeration Date | 2016-10-25 |
| Last Update Date | 2016-10-25 |