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General NPI Number Information
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NPI Number | 1588279152
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Entity Type | Organization
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Legal Business Name | SEEDS WILDERNESS THERAPY
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Dates
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Enumeration Date | 09/10/2020
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Last Update Date | 05/09/2022
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Provider Practice Location Address
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Address Line | 1771 N TOWNSEND AVE
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City | MONTROSE
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State | CO
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Zip | 81401-5932
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Country | US
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Telephone | 970-765-8919
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Fax |
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Provider Business Mailing Address
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Address Line | 1771 N TOWNSEND AVE
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City | MONTROSE
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State | CO
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Zip | 81401-5932
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Country | US
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Telephone | 719-970-5965
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Fax |
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Authorized Official
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Title or Position | DIRECTOR OPERATIONS
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Name | DWIGHT GRANT
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Credential | MBA
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Telephone | 719-426-7643
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 323P00000X
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Taxonomy Name | Psychiatric Residential Treatment Facility
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License Number |
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License Number State |
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