| NPI | 1730596032 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JESSICA KRUCKEBERG Owner 720-288-0645 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health (Licence: CO 0104134) |
| Enumeration Date | 2014-07-18 |
| Last Update Date | 2014-07-18 |