| NPI | 1992671481 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | NATHANIEL BRYCE WILSON Owner 719-694-9739 |
| Organization Subpart ? | No |
| Primary Taxonomy | 324500000X Substance Abuse Rehabilitation Facility |
| Enumeration Date | 2025-10-13 |
| Last Update Date | 2025-10-13 |