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General NPI Number Information
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NPI Number | 1043342793
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Entity Type | Organization
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Legal Business Name | COLORADO MENTAL HEALTH INSTITUTE PUEBLO
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Dates
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Enumeration Date | 03/09/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1600 W 24TH ST
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City | PUEBLO
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State | CO
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Zip | 81003-1411
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Country | US
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Telephone | 719-546-4000
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Fax | 719-546-4484
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Provider Business Mailing Address
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Address Line | 1600 W 24TH ST
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City | PUEBLO
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State | CO
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Zip | 81003-1411
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Country | US
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Telephone | 719-546-4000
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Fax | 719-546-4484
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Authorized Official
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Title or Position | HIPAA OFFICER
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Name | MRS. KAT FOO
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Credential |
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Telephone | 303-866-5871
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 273R00000X
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Taxonomy Name | Psychiatric Hospital Unit
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License Number | 0236
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License Number State | CO
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