| Wcmhc-adad | |
|
3225 Independence Rd Canon City CO 81212-9380 | |
| (719) 275-2351 | |
| (719) 269-9386 |
| Full Name | Wcmhc-adad |
|---|---|
| Speciality | Clinic/center - Mental Health (including Community Mental Health Center) |
| Location | 3225 Independence Rd, Canon City, Colorado |
| Authorized Official Name and Position | Mandy Jo Kaisner (CHIEF EXECUTIVE OFFICER) |
| Authorized Official Contact | 7192752351 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Wcmhc-adad 3225 Independence Rd Canon City CO 81212-9380 Ph: (719) 275-2351 | Wcmhc-adad 3225 Independence Rd Canon City CO 81212-9380 Ph: (719) 275-2351 |
| NPI Number | 1245518968 |
|---|---|
| Provider Enumeration Date | 07/29/2011 |
| Last Update Date | 05/08/2024 |
| Certification Date | 05/08/2024 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1245518968 | NPI | - | NPPES |
| 80125328 | Medicaid | CO |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | (* (Not Available)) | Primary |
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