| NPI | 1871622738 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARY L DICE CFO 719-572-7447 |
| Organization Subpart ? | No |
| Primary Taxonomy | 311ZA0620X Custodial Care Facility Adult Care Home (Licence: CO 0620) |
| Enumeration Date | 2007-03-05 |
| Last Update Date | 2021-07-15 |