Organization
GRAND SLAM SUPPORTS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TYLER PATTY (OWNER)
(316) 323-9734
Entity
Organization
Contact information
Practice address
2313 DUNBAR CT, LONGMONT, CO 80501-1009
(316) 323-9734
Mailing address
2313 DUNBAR CT, LONGMONT, CO 80501-1009
(316) 323-9734
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
—
—
Other
Enumeration date
12/17/2018
Last updated
12/17/2018
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