| NPI | 1982470936 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | NATE WILSON Owner 719-640-0668 |
| Organization Subpart ? | No |
| Primary Taxonomy | 324500000X Substance Abuse Rehabilitation Facility |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) |
| 103TA0400X Psychologist, Addiction (Substance Use Disorder) | |
| Enumeration Date | 2023-11-30 |
| Last Update Date | 2023-12-08 |