Healthcare Provider Details

I. General information

NPI: 1295903045
Provider Name (Legal Business Name): SOUTHERN COLORADO ADDICTION RECOVERY CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/14/2008
Last Update Date: 02/14/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5250 PIKES PEAK HWY
CASCADE CO
80809-1110
US

IV. Provider business mailing address

225 N WEBER ST
COLORADO SPRINGS CO
80903-1309
US

V. Phone/Fax

Practice location:
  • Phone: 719-217-5082
  • Fax:
Mailing address:
  • Phone: 719-508-2217
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number
License Number State

VIII. Authorized Official

Name: MR. MICHAEL J. MCKELVEY
Title or Position: EXECUTIVE DIRECTOR
Credential: ADMINISTRATOR
Phone: 719-217-5082