Healthcare Provider Details

I. General information

NPI: 1497024590
Provider Name (Legal Business Name): COMCOR, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/19/2011
Last Update Date: 12/19/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3615 ROBERTS RD
COLORADO SPRINGS CO
80907-5301
US

IV. Provider business mailing address

3615 ROBERTS RD
COLORADO SPRINGS CO
80907-5301
US

V. Phone/Fax

Practice location:
  • Phone: 719-473-4460
  • Fax:
Mailing address:
  • Phone: 719-473-4460
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number1421-00
License Number StateCO

VIII. Authorized Official

Name: SUSAN KUIPER
Title or Position: ADMINISTRATIVE SUPPORT MANAGER
Credential:
Phone: 719-473-4460