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1600 W 24th St Pueblo CO 81003-1411 | |
| (719) 546-4000 | |
| (719) 546-4484 |
| Full Name | |
|---|---|
| Speciality | Psychiatric Unit |
| Location | 1600 W 24th St, Pueblo, Colorado |
| Authorized Official Name and Position | Kat Foo (HIPAA OFFICER) |
| Authorized Official Contact | 3038665871 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
3520 W Oxford Ave Denver CO 80236-3108 Ph: (303) 866-7080 | 1600 W 24th St Pueblo CO 81003-1411 Ph: (719) 546-4000 |
| NPI Number | 1962535229 |
|---|---|
| Provider Enumeration Date | 03/14/2007 |
| Last Update Date | 08/22/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1962535229 | NPI | - | NPPES |
| 11334045 | Medicaid | CO |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 273R00000X | Psychiatric Unit | 0196 (Colorado) | Primary |
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