Healthcare Provider Details

I. General information

NPI: 1043342793
Provider Name (Legal Business Name): COLORADO MENTAL HEALTH INSTITUTE PUEBLO
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/09/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 W 24TH ST
PUEBLO CO
81003-1411
US

IV. Provider business mailing address

1600 W 24TH ST
PUEBLO CO
81003-1411
US

V. Phone/Fax

Practice location:
  • Phone: 719-546-4000
  • Fax: 719-546-4484
Mailing address:
  • Phone: 719-546-4000
  • Fax: 719-546-4484

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code273R00000X
TaxonomyPsychiatric Hospital Unit
License Number0236
License Number StateCO

VIII. Authorized Official

Name: MRS. KAT FOO
Title or Position: HIPAA OFFICER
Credential:
Phone: 303-866-5871