| NPI | 1902159668 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ELISA LEAKE President 719-622-1708 |
| Organization Subpart ? | No |
| Primary Taxonomy | 311ZA0620X Custodial Care Facility Adult Care Home (Licence: CO 04K999) |
| Enumeration Date | 2012-10-18 |
| Last Update Date | 2012-10-18 |