| NPI | 1790299725 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LISA M PAYNE Official Agent 719-214-4755 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251B00000X Case Management |
| Additional Taxonomies | 175T00000X Peer Specialist (Licence: CO 0000444) |
| 251S00000X | |
| Enumeration Date | 2017-11-29 |
| Last Update Date | 2020-01-23 |