Healthcare Provider Details

I. General information

NPI: 1932953445
Provider Name (Legal Business Name): PURPLE MOUNTAIN RECOVERY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/12/2024
Last Update Date: 10/08/2024
Certification Date: 10/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3225 AUSTIN BLUFFS PKWY STE 100
COLORADO SPRINGS CO
80918-5768
US

IV. Provider business mailing address

3225 AUSTIN BLUFFS PKWY STE 100
COLORADO SPRINGS CO
80918-5768
US

V. Phone/Fax

Practice location:
  • Phone: 719-445-0621
  • Fax:
Mailing address:
  • Phone: 719-445-0621
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2084P0802X
TaxonomyAddiction Psychiatry Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: SCOTT MOSHER-RAMIREZ
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 719-445-0621