Healthcare Provider Details

I. General information

NPI: 1508250911
Provider Name (Legal Business Name): SPANISH PEAKS NEW ALTERNATIVES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/24/2015
Last Update Date: 12/01/2020
Certification Date: 12/01/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

41 MONTEBELLO RD SUITE 116
PUEBLO CO
81001-1379
US

IV. Provider business mailing address

41 MONTEBELLO RD STE 204
PUEBLO CO
81001-1379
US

V. Phone/Fax

Practice location:
  • Phone: 719-545-2746
  • Fax: 719-545-4100
Mailing address:
  • Phone: 719-545-2746
  • Fax: 719-545-4100

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DOROTHY PERRY
Title or Position: CEO
Credential: PH.D.. M. ED., MBA
Phone: 719-545-2746