MEDICARE: HALO REENTRY LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251S00000X	Community/Behavioral Health Agency

General Provider Information

NPI Number	:	1477486322
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HALO REENTRY LLC

Provider Business Mailing Address
First Line	:	1465 PETERSON RD
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80915-3138
Country	:	US
Telephone Number	:	719-644-4387
Fax Number	:

Provider Business Practice Location Address
First Line	:	2020 N ACADEMY BLVD STE 210
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80909-1568
Country	:	US
Telephone Number	:	719-644-4387
Fax Number	:

Authorized Official
Title or Position	:	OWNER/DIRECTOR
Name	:	JEREMY J PAVLIK
Credential	:
Telephone Number	:	719-644-4387

Provider Enumeration Date	:	06/08/2026
Last Update Date	:	06/08/2026

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Directions to “HALO REENTRY LLC ” Practice Location

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