Healthcare Provider Details

I. General information

NPI: 1659751501
Provider Name (Legal Business Name): SPRINGBOK HEALTH INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/05/2015
Last Update Date: 06/12/2026
Certification Date: 06/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1115 N GRAND AVE
PUEBLO CO
81003-2867
US

IV. Provider business mailing address

1318 W COLORADO AVE
COLORADO SPRINGS CO
80904-4023
US

V. Phone/Fax

Practice location:
  • Phone: 719-766-8511
  • Fax: 866-869-4994
Mailing address:
  • Phone: 719-766-8511
  • Fax: 866-869-4994

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateNULL

VIII. Authorized Official

Name: MARK JANKELOW
Title or Position: CEO/OWNER
Credential: PMHNP-BC
Phone: 719-766-8511