Healthcare Provider Details

I. General information

NPI: 1285581322
Provider Name (Legal Business Name): CHERISH LIFE MENTORSHIP PROGRAM
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/16/2026
Last Update Date: 03/16/2026
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

173 E. COUNTRYSIDE DR
PUEBLO WEST CO
81007
US

IV. Provider business mailing address

173 E. COUNTRYSIDE DR
PUEBLO WEST CO
81007
US

V. Phone/Fax

Practice location:
  • Phone: 719-415-5872
  • Fax:
Mailing address:
  • Phone: 719-415-5872
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code405300000X
TaxonomyPrevention Professional
License Number
License Number State

VIII. Authorized Official

Name: MS. CAROL ANN SPENCE
Title or Position: FOUNDER/VICE PRESIDENT
Credential:
Phone: 719-415-5872