| NPI | 1760922884 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SANDRA RAE GOODWIN Part Owner/ Co Director 719-589-6438 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health (Licence: CO 1653-00) |
| Enumeration Date | 2017-03-08 |
| Last Update Date | 2017-03-08 |