Individual
SANDRA DOUGLAS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
3109 66TH AVE, GREELEY, CO 80634-8932
(314) 413-0043
Mailing address
3109 66TH AVE, GREELEY, CO 80634-8932
Taxonomy
Speciality
Code
Description
License number
State
320600000X
Intellectual and/or Developmental Disabilities Residential Treatment Facility
Primary
—
—
Other
Enumeration date
07/26/2017
Last updated
07/26/2017
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