| Project Pueblo | |
|
117 Fairway Vlg Pueblo West CO 81007-3621 | |
| (303) 908-8623 | |
| Not Available |
| Full Name | Project Pueblo |
|---|---|
| Speciality | Community/behavioral Health |
| Location | 117 Fairway Vlg, Pueblo West, Colorado |
| Authorized Official Name and Position | Earl R Poteet (PRESIDENT) |
| Authorized Official Contact | 3039088623 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Project Pueblo 117 Fairway Vlg Pueblo West CO 81007-3621 Ph: (303) 908-8623 | Project Pueblo 117 Fairway Vlg Pueblo West CO 81007-3621 Ph: (303) 908-8623 |
| NPI Number | 1245513399 |
|---|---|
| Provider Enumeration Date | 09/26/2011 |
| Last Update Date | 09/26/2011 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1245513399 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | CSW 1809 (Colorado) | Primary |
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