| State Of Grace | |
|
720 N Main St Ste 330 Pueblo CO 81003-3047 | |
| (719) 569-7909 | |
| Not Available |
| Full Name | State Of Grace |
|---|---|
| Speciality | Clinic/center - Mental Health (including Community Mental Health Center) |
| Location | 720 N Main St Ste 330, Pueblo, Colorado |
| Authorized Official Name and Position | Robert R Maes (CLINICAL DIRECTOR) |
| Authorized Official Contact | 7195697909 |
| 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 | 1457950958 |
|---|---|
| Provider Enumeration Date | 10/26/2020 |
| Last Update Date | 04/15/2021 |
| Certification Date | 04/15/2021 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1457950958 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | (* (Not Available)) | Primary |
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