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2713 N Grand Ave Pueblo CO 81003-2453 | |
| (719) 545-2564 | |
| Not Available |
| Full Name | |
|---|---|
| Speciality | Community/behavioral Health |
| Location | 2713 N Grand Ave, Pueblo, Colorado |
| Authorized Official Name and Position | Elissa Ball (VOLUNTEER EXECUTIVE DIRECTOR) |
| Authorized Official Contact | 7192146081 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
2713 N Grand Ave Pueblo CO 81003-2453 Ph: (719) 545-2564 | 2713 N Grand Ave Pueblo CO 81003-2453 Ph: (719) 545-2564 |
| NPI Number | 1578199576 |
|---|---|
| Provider Enumeration Date | 03/21/2020 |
| Last Update Date | 04/02/2020 |
| Certification Date | 04/02/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1578199576 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | (* (Not Available)) | Primary |
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