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General NPI Number Information
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NPI Number | 1215304605
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Entity Type | Organization
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Legal Business Name | ELK FAMILY RECOVERY
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Dates
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Enumeration Date | 09/01/2015
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Last Update Date | 12/30/2016
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Provider Practice Location Address
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Address Line | 400 ALEXANDER LN
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City | BASALT
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State | CO
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Zip | 81621-8117
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Country | US
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Telephone | 970-927-0556
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Fax |
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Provider Business Mailing Address
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Address Line | 400 ALEXANDER LN
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City | BASALT
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State | CO
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Zip | 81621-8117
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Country | US
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Telephone | 970-927-0556
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Fax |
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Authorized Official
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Title or Position | PROGRAM DIRECTOR
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Name | MR. BRAD OSBORN
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Credential | CACIII, CAI
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Telephone | 970-927-0556
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QR0405X
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Taxonomy Name | Substance Use Disorder Rehabilitation Clinic/Center
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License Number |
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License Number State |
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