| Genesis- Prevent Protect Provide | |
|
379 Chalice Rd. Westcliffe CO 81252 | |
| (719) 371-2472 | |
| Not Available |
| Full Name | Genesis- Prevent Protect Provide |
|---|---|
| Speciality | Social Worker - Clinical |
| Location | 379 Chalice Rd., Westcliffe, Colorado |
| Authorized Official Name and Position | Fawnda Newton (EXECUTIVE DIRECTOR) |
| Authorized Official Contact | 7193712472 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Genesis- Prevent Protect Provide Po Box 744 Westcliffe CO 81252-0744 Ph: (719) 371-2472 | Genesis- Prevent Protect Provide 379 Chalice Rd. Westcliffe CO 81252 Ph: (719) 371-2472 |
| NPI Number | 1184323636 |
|---|---|
| Provider Enumeration Date | 02/23/2023 |
| Last Update Date | 02/23/2023 |
| Certification Date | 02/22/2023 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1184323636 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 104100000X | Social Worker | (* (Not Available)) | Secondary |
| 1041C0700X | Social Worker - Clinical | (* (Not Available)) | Primary |
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