| Shadow Mountain Recovery, Colorado Springs | |
|
1155 Kelly Johnson Blvd Suite 201 Colorado Springs CO 80920-3932 | |
| (719) 418-3737 | |
| Not Available |
| Full Name | Shadow Mountain Recovery, Colorado Springs |
|---|---|
| Speciality | Substance Abuse Rehabilitation Facility |
| Location | 1155 Kelly Johnson Blvd, Colorado Springs, Colorado |
| Authorized Official Name and Position | Jackie Holub (VICE PRESIDENT) |
| Authorized Official Contact | 9253898591 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Shadow Mountain Recovery, Colorado Springs Po Box 830525 Department # Sf 58 Birmingham AL 35283-0525 Ph: (931) 451-7757 | Shadow Mountain Recovery, Colorado Springs 1155 Kelly Johnson Blvd Suite 201 Colorado Springs CO 80920-3932 Ph: (719) 418-3737 |
| NPI Number | 1801226709 |
|---|---|
| Provider Enumeration Date | 11/14/2013 |
| Last Update Date | 02/27/2017 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1801226709 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | 1746-01 (Colorado) | Secondary |
| 324500000X | Substance Abuse Rehabilitation Facility | (* (Not Available)) | Primary |
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