Healthcare Provider Details

I. General information

NPI: 1073361440
Provider Name (Legal Business Name): CAST COLORADO, LLC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/09/2024
Last Update Date: 08/14/2026
Certification Date: 08/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15 SPRUCE ST.
LA JARA CO
81140
US

IV. Provider business mailing address

1317 17TH ST
ALAMOSA CO
81101-3555
US

V. Phone/Fax

Practice location:
  • Phone: 719-206-4673
  • Fax: 719-435-4228
Mailing address:
  • Phone: 719-206-4673
  • Fax: 719-435-4228

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number
License Number State

VIII. Authorized Official

Name: KIMBERLY REED
Title or Position: CO-FOUNDER. CEO. VICE-CHAIRMAN, & O
Credential:
Phone: 720-833-8453