Organization
FRIENDS OF CLUB 21
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JOSEPH MASON (CHIEF OPERATING OFFICER)
(360) 789-4935
Entity
Organization
Contact information
Practice address
301 AUSTIN BLUFFS PKWY, COLORADO SPRINGS, CO 80918-3922
(360) 789-4935
Mailing address
3472 RESEARCH PKWY STE 104-405, COLORADO SPRINGS, CO 80920-1066
(360) 789-4935
Taxonomy
Speciality
Code
Description
License number
State
373H00000X
Day Training/Habilitation Specialist
Primary
—
—
Other
Enumeration date
10/27/2025
Last updated
10/27/2025
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