| NPI | 1891345807 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LISA CHAVEZ Contract & Credentialing Manager 719-383-5448 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) |
| Additional Taxonomies | 261QR0405X Clinic/Center, Rehabilitation, Substance Use Disorder |
| Enumeration Date | 2019-09-12 |
| Last Update Date | 2022-09-13 |