Organization
MIKE'S PLACE LLC
Active
Organization
MIKE'S PLACE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
REBECCA L YOUNG (DIRECTOR)
(970) 319-8496
Entity
Organization
Contact information
Practice address
325 GARFIELD AVENUE, CARBONDALE, CO 81623
(970) 319-8496
Mailing address
323 GARFIELD AVENUE, CARBONDALE, CO 81623
(970) 319-8496
Taxonomy
Speciality
Code
Description
License number
State
251C00000X
Developmentally Disabled Services Day Training Agency
—
—
251S00000X
Community/Behavioral Health Agency
—
—
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
48808717
—
CO
Enumeration date
10/14/2020
Last updated
10/14/2020
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