Organization
AMISTAD OF SAN LUIS, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. JUDITH ANN FUNK (OWNER/DIRECTOR)
(719) 588-9903
Entity
Organization
Contact information
Practice address
403 MAIN STREET, SAN LUIS, CO 81152-0674
(719) 672-0892
(719) 672-0892
Mailing address
403 MAIN STREET, P.O.BOX 674, SAN LUIS, CO 81152-0674
(719) 672-0892
(719) 672-0892
Taxonomy
Speciality
Code
Description
License number
State
261QA0600X
Adult Day Care Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
68058217
—
CO
Enumeration date
02/04/2016
Last updated
02/04/2016
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