Healthcare Provider Details

I. General information

NPI: 1477227015
Provider Name (Legal Business Name): 702 POINT PLACE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/06/2021
Last Update Date: 05/25/2022
Certification Date: 05/25/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3680 PONY TRACKS DR
COLORADO SPRINGS CO
80922-3062
US

IV. Provider business mailing address

3680 PONY TRACKS DR
COLORADO SPRINGS CO
80922-3062
US

V. Phone/Fax

Practice location:
  • Phone: 719-654-4143
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code320600000X
TaxonomyIntellectual and/or Developmental Disabilities Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name: AMBER SUAREZ
Title or Position: DIRECTOR/OWNER
Credential:
Phone: 702-328-4634