| NPI | 1740877489 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BANAFSHE' KING Credentialing & Enrollment Spec 719-419-7959 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QR0405X Clinic/Center, Rehabilitation, Substance Use Disorder |
| Additional Taxonomies | 251S00000X Community/Behavioral Health |
| Enumeration Date | 2020-12-29 |
| Last Update Date | 2025-07-02 |