Healthcare Provider Details

I. General information

NPI: 1629670088
Provider Name (Legal Business Name): CATHOLIC CHARITIES OF THE DIOCESE OF PUEBLO
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/11/2020
Last Update Date: 11/11/2020
Certification Date: 10/16/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

429 W 10TH ST
PUEBLO CO
81003-2941
US

IV. Provider business mailing address

429 W 10TH ST
PUEBLO CO
81003-2941
US

V. Phone/Fax

Practice location:
  • Phone: 719-544-4233
  • Fax:
Mailing address:
  • Phone: 719-544-4233
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License Number
License Number State

VIII. Authorized Official

Name: IDA RHODES
Title or Position: INTERIM EXECUTIVE DIRECTOR
Credential:
Phone: 719-586-8609