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1012 W Abriendo Ave Pueblo CO 81004-1128 | |
| (719) 545-2746 | |
| Not Available |
| Full Name | |
|---|---|
| Speciality | Clinic/center - Rehabilitation, Substance Use Disorder |
| Location | 1012 W Abriendo Ave, Pueblo, Colorado |
| Authorized Official Name and Position | Jennifer Rudnik (PRESIDENT/CEO) |
| Authorized Official Contact | 7195452746 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
41 Montebello Rd Ste 204 Pueblo CO 81001-1379 Ph: (719) 545-2746 | 1012 W Abriendo Ave Pueblo CO 81004-1128 Ph: (719) 545-2746 |
| NPI Number | 1891392759 |
|---|---|
| Provider Enumeration Date | 10/05/2020 |
| Last Update Date | 06/02/2022 |
| Certification Date | 06/02/2022 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1891392759 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0850X | Clinic/center - Adult Mental Health | (* (Not Available)) | Secondary |
| 261QR0405X | Clinic/center - Rehabilitation, Substance Use Disorder | (* (Not Available)) | Primary |
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