Healthcare Provider Details

I. General information

NPI: 1780192989
Provider Name (Legal Business Name): CHILD COMMUNITY SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/22/2018
Last Update Date: 10/28/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2210 E LA SALLE ST # 108
COLORADO SPRINGS CO
80909-2303
US

IV. Provider business mailing address

2210 E LA SALLE ST STE 108
COLORADO SPRINGS CO
80909-2303
US

V. Phone/Fax

Practice location:
  • Phone: 719-440-6445
  • Fax:
Mailing address:
  • Phone: 719-440-6445
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateCO

VIII. Authorized Official

Name: CHRISTINE TALBOTT
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 719-440-6445