| Respite Suite 104 | |
|
41 Montebello Rd Ste 104 Pueblo CO 81001-1366 | |
| (719) 545-2746 | |
| Not Available |
| Full Name | Respite Suite 104 |
|---|---|
| Speciality | Respite Care |
| Location | 41 Montebello Rd Ste 104, Pueblo, Colorado |
| Authorized Official Name and Position | Jennifer Rudnik (CREDENTIALING MANAGER) |
| Authorized Official Contact | 7194231341 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Respite Suite 104 41 Montebello Rd Ste 204 Pueblo CO 81001-1379 Ph: (719) 545-2746 | Respite Suite 104 41 Montebello Rd Ste 104 Pueblo CO 81001-1366 Ph: (719) 545-2746 |
| NPI Number | 1548932551 |
|---|---|
| Provider Enumeration Date | 09/29/2021 |
| Last Update Date | 06/09/2022 |
| Certification Date | 06/09/2022 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1548932551 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | (* (Not Available)) | Secondary |
| 385H00000X | Respite Care | (* (Not Available)) | Primary |
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