Organization
HISTORIC PINES YOUTH RANCH LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CHRISTY PECK KANE HMC (DIRECTOR)
(702) 430-6206
Entity
Organization
Contact information
Practice address
379 CHALICE DRIVE, WESTCLIFFE, CO 81252
(801) 735-5971
(775) 549-8800
Mailing address
PO BOX 311, WESTCLIFFE, CO 81252-0311
(801) 735-5971
(775) 549-8800
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
—
—
323P00000X
Psychiatric Residential Treatment Facility
Primary
—
—
Other
Enumeration date
07/28/2010
Last updated
07/28/2010
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