Organization
INSPIRATION FIELD
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ROSA SALO (CFO)
(719) 384-8741
Entity
Organization
Contact information
Practice address
2112 COLORADO AVE, LA JUNTA, CO 81050-3419
(719) 384-8741
Mailing address
612 ADAMS AVE, LA JUNTA, CO 81050-2535
Taxonomy
Speciality
Code
Description
License number
State
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
Primary
05Z791
CO
Other
Enumeration date
10/24/2016
Last updated
10/24/2016
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