Healthcare Provider Details

I. General information

NPI: 1336706456
Provider Name (Legal Business Name): STEEL CITY RESIDENTIAL AND SUPPORT SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/23/2019
Last Update Date: 05/23/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21 DUNDEE LN
PUEBLO CO
81001-1727
US

IV. Provider business mailing address

21 DUNDEE LN
PUEBLO CO
81001-1727
US

V. Phone/Fax

Practice location:
  • Phone: 719-242-3458
  • Fax:
Mailing address:
  • Phone: 719-242-3458
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code320900000X
TaxonomyIntellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code347E00000X
TaxonomyTransportation Broker
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number
License Number State

VIII. Authorized Official

Name: MARY V ARAGON
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 719-242-3458