| NPI | 1760275598 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LAWRENCE WALL Director 970-404-5872 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 261QR0405X Clinic/Center, Rehabilitation, Substance Use Disorder |
| Enumeration Date | 2025-05-24 |
| Last Update Date | 2025-05-24 |