Extreme Sports Camp

NPI #1669744637 in Basalt, Colorado

Provider Information

NPI Number: 1669744637
Entity Type: Organization
Organization Name: Extreme Sports Camp
Primary Specialty: Counselor
Enumeration Date: Feb 6, 2012
Last Updated: Feb 6, 2012

Practice Location

Address: 23286 TWO RIVERS RD
Address 2: SUITE 24-A
City: Basalt
State: Colorado
ZIP Code: 81621-9285
Phone: (970) 927-3143

Authorized Official

Name: MRS. SALLIE BERNARD
Title: EXECUTIVE DIRECTOR
Phone: (970) 927-0433

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Counselor	101Y00000X	Primary

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