| NPI | 1962220533 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JUDY ELLYNNE PRATT Credentialing Specialist 720-617-2645 |
| Organization Subpart ? | No |
| Primary Taxonomy | 324500000X Substance Abuse Rehabilitation Facility |
| Additional Taxonomies | 3245S0500X Substance Abuse Rehabilitation Facility Substance Abuse Treatment, Children |
| Enumeration Date | 2024-10-01 |
| Last Update Date | 2024-10-01 |