Healthcare Provider Details

I. General information

NPI: 1023620440
Provider Name (Legal Business Name): PEER COACH ACADEMY COLORADO
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/18/2020
Last Update Date: 12/18/2025
Certification Date: 12/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

411 S CASCADE AVE STE 100
COLORADO SPRINGS CO
80903-3811
US

IV. Provider business mailing address

411 S CASCADE AVE STE 100
COLORADO SPRINGS CO
80903-3811
US

V. Phone/Fax

Practice location:
  • Phone: 800-604-8978
  • Fax:
Mailing address:
  • Phone: 800-604-8978
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: ROD E RUSHING
Title or Position: DIRECTOR
Credential: CACIII
Phone: 720-435-5320