| NPI | 1942852561 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | EDEN FANTAHUN Administrator 720-646-6281 |
| Organization Subpart ? | No |
| Primary Taxonomy | 320900000X Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities |
| Enumeration Date | 2019-07-13 |
| Last Update Date | 2019-07-13 |