Healthcare Provider Details

I. General information

NPI: 1730711862
Provider Name (Legal Business Name): CENTURA VENTURES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/06/2020
Last Update Date: 11/12/2024
Certification Date: 11/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4112 OUTLOOK BLVD STE 96
PUEBLO CO
81008-1667
US

IV. Provider business mailing address

PO BOX 801172
KANSAS CITY MO
64180-1172
US

V. Phone/Fax

Practice location:
  • Phone: 719-562-6200
  • Fax: 719-562-6225
Mailing address:
  • Phone: 800-953-0104
  • Fax: 303-765-6670

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code225400000X
TaxonomyRehabilitation Practitioner
License Number
License Number StateNULL

VIII. Authorized Official

Name: MS. DEBRA CARPENTER
Title or Position: VP, AMBULATORY SERVICES
Credential: RN
Phone: 303-765-6998