Organization
SUCAP
Active
Other names
Peaceful Spirit Treatment Center
Organization subpart
No
Provider details
NPI number
Authorized official
ELAINE WASSERBACH M.A. (DIRECTOR)
(970) 563-4517
Entity
Organization
Contact information
Practice address
296 MOUACHE RD., IGNACIO, CO 81137-0429
(970) 563-4555
(970) 563-4618
Mailing address
296 MOUACHE RD., IGNACIO, CO 81137-0429
(970) 563-4555
(970) 563-4618
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
1445
CO
324500000X
Substance Abuse Rehabilitation Facility
116600
CO
Other
Enumeration date
04/17/2009
Last updated
04/17/2009
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