| NPI | 1912330101 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | NICOLE MILLER Provider 970-290-8172 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health (Licence: CO 11582) |
| Enumeration Date | 2013-08-12 |
| Last Update Date | 2013-08-12 |