Healthcare Provider Details

I. General information

NPI: 1689812059
Provider Name (Legal Business Name): CENTER FOR DISABILITIES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/23/2009
Last Update Date: 02/06/2020
Certification Date: 02/06/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

901 WEST 8TH STREET
PUEBLO CO
81003-2003
US

IV. Provider business mailing address

901 WEST 8TH STREET
PUEBLO CO
81003-2003
US

V. Phone/Fax

Practice location:
  • Phone: 719-546-1271
  • Fax: 719-546-1374
Mailing address:
  • Phone: 719-546-1271
  • Fax: 719-546-1374

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171WH0202X
TaxonomyHome Modifications Contractor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

Name: MR. WILLIAM CLYDE EDWARDS
Title or Position: EXECUTIVE DIRECTOR
Credential: TH.M.
Phone: 719-546-1271