Organization
PEACEFUL SPIRIT/SUCAP
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. DENNIS WILLIAM DAHLKE MED, CACIII, LPC (PROGRAM DIRECTOR)
(970) 563-4555
Entity
Organization
Contact information
Practice address
296 MOUACHE DRIVE, IGNACIO, CO 81137-0429
(970) 563-4555
(970) 563-4618
Mailing address
PO BOX 429, IGNACIO, CO 81137-0429
(970) 563-4555
(970) 563-4618
Taxonomy
Speciality
Code
Description
License number
State
324500000X
Substance Abuse Rehabilitation Facility
Primary
1390
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1390
COLORADO STATE DEPARTMENT OF REGLATORY AGENCY
CO
Enumeration date
04/13/2009
Last updated
04/13/2009
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