| State Of Grace | |
|
720 N Main St Ste 330 Pueblo CO 81003-3047 | |
| (719) 569-7909 | |
| Not Available |
| Full Name | State Of Grace |
|---|---|
| Speciality | Community/behavioral Health |
| Location | 720 N Main St Ste 330, Pueblo, Colorado |
| Authorized Official Name and Position | Robert Richard Maes (CLINICAL DIRECTOR) |
| Authorized Official Contact | 7192401799 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| State Of Grace 720 N Main St Ste 330 Pueblo CO 81003-3047 Ph: (719) 569-7909 | State Of Grace 720 N Main St Ste 330 Pueblo CO 81003-3047 Ph: (719) 569-7909 |
| NPI Number | 1164775250 |
|---|---|
| Provider Enumeration Date | 10/26/2012 |
| Last Update Date | 04/15/2021 |
| Certification Date | 04/15/2021 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1164775250 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | 1727-01 (Colorado) | Primary |
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