Healthcare Provider Details

I. General information

NPI: 1710664271
Provider Name (Legal Business Name): COACH RECOVERY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/28/2023
Last Update Date: 06/19/2026
Certification Date: 06/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2111 CLARKSON DR
COLORADO SPRINGS CO
80909-2063
US

IV. Provider business mailing address

2111 CLARKSON DR
COLORADO SPRINGS CO
80909-2063
US

V. Phone/Fax

Practice location:
  • Phone: 719-517-8059
  • Fax:
Mailing address:
  • Phone: 719-517-8059
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code171400000X
TaxonomyHealth & Wellness Coach
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number State

VIII. Authorized Official

Name: ADAM T ADKINS
Title or Position: OWNER
Credential: QBHA CEO
Phone: 719-517-8059