| Rugged Cross Miracle Ranch | |
|
13990 Windy Pine Dr Elbert CO 80106 | |
| (719) 327-0656 | |
| (719) 327-0657 |
| Full Name | Rugged Cross Miracle Ranch |
|---|---|
| Speciality | Marriage & Family Therapist |
| Location | 13990 Windy Pine Dr, Elbert, Colorado |
| Authorized Official Name and Position | Deborah L Dewitt (VICE PRESIDENT) |
| Authorized Official Contact | 7193270656 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Rugged Cross Miracle Ranch 13990 Windy Pine Dr Elbert CO 80106-8874 Ph: (719) 327-0656 | Rugged Cross Miracle Ranch 13990 Windy Pine Dr Elbert CO 80106 Ph: (719) 327-0656 |
| NPI Number | 1295250900 |
|---|---|
| Provider Enumeration Date | 08/03/2017 |
| Last Update Date | 11/20/2023 |
| Certification Date | 11/20/2023 |
| Medicare PECOS PAC ID | 6103275813 |
|---|---|
| Medicare Enrollment ID | O20231206003104 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1295250900 | NPI | - | NPPES |
| 0000000000 | Other | DO NOT HAVE ANY ADDITIONAL PROVIDER ID'S |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 106H00000X | Marriage & Family Therapist | 1076 (Colorado) | Primary |
| Provider Name | Deborah L Dewitt |
|---|---|
| Provider Type | Practitioner - Marriage And Family Therapist |
| Provider Identifiers | NPI Number: 1588111926 PECOS PAC ID: 4284083999 Enrollment ID: I20231206003729 |
Stablestrides Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 13620 Halleluiah Trl, Elbert, CO 80106 Phone: 719-495-3908 Fax: 719-494-1689 | |
Brite Beginnings Mental Health Clinic Medicare: Medicare Enrolled Practice Location: 14195 Delwood Dr, Elbert, CO 80106 Phone: 720-648-2654 Fax: 800-540-0328 |