Organization
LESLIE POTTEBAUM
Active
Other names
Cy-Les Ranch
Organization subpart
No
Provider details
NPI number
Authorized official
LESLIE POTTEBAUM (SOLE PROPRIETOR)
(303) 912-1111
Entity
Organization
Contact information
Practice address
16155 W 74TH DR, ARVADA, CO 80007-7828
(303) 912-1111
Mailing address
16155 W 74TH DR, ARVADA, CO 80007-7828
(303) 912-1111
Taxonomy
Speciality
Code
Description
License number
State
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
Primary
—
—
Other
Enumeration date
07/17/2019
Last updated
07/26/2024
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