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 |