| Forensic Under 21 | |
|
1600 W 24th St Pueblo CO 81003-1411 | |
| (719) 546-4000 | |
| (719) 546-4484 |
| Full Name | Forensic Under 21 |
|---|---|
| Speciality | Psychiatric Unit |
| Location | 1600 W 24th St, Pueblo, Colorado |
| Authorized Official Name and Position | Victoria Trapp (DEPUTY DIRECTOR) |
| Authorized Official Contact | 7207012169 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Forensic Under 21 1600 W 24th St Pueblo CO 81003-1411 Ph: (719) 546-4000 | Forensic Under 21 1600 W 24th St Pueblo CO 81003-1411 Ph: (719) 546-4000 |
| NPI Number | 1235261637 |
|---|---|
| Provider Enumeration Date | 03/12/2007 |
| Last Update Date | 06/15/2020 |
| Certification Date | 06/15/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1235261637 | NPI | - | NPPES |
| 88977048 | Medicaid | CO | |
| 03211885 | Medicaid | CO |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 273R00000X | Psychiatric Unit | 0295 (Colorado) | Primary |
| 3336L0003X | Pharmacy - Long Term Care Pharmacy | (* (Not Available)) | Secondary |
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