Healthcare Provider Details

I. General information

NPI: 1952215220
Provider Name (Legal Business Name): ROAD 2 RECOVERY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/01/2026
Last Update Date: 10/01/2026
Certification Date: 10/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1120 W NORTHERN AVE
PUEBLO CO
81004-2852
US

IV. Provider business mailing address

1120 W NORTHERN AVE
PUEBLO CO
81004-2852
US

V. Phone/Fax

Practice location:
  • Phone: 720-338-0393
  • Fax:
Mailing address:
  • Phone: 720-338-0393
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number StateNULL

VIII. Authorized Official

Name: IGNACIO ELI MARTINEZ
Title or Position: OWNER
Credential:
Phone: 720-338-0393