| NPI | 1972049245 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TRUDY ANN SICOTTE Nurse Practitioner 719-269-5081 |
| Organization Subpart ? | No |
| Primary Taxonomy | 311Z00000X Custodial Care Facility (Licence: CO 0004895) |
| Enumeration Date | 2017-01-11 |
| Last Update Date | 2017-01-11 |