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General NPI Number Information
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NPI Number | 1235760521
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Entity Type | Organization
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Legal Business Name | A SAFE PLACE IN PAGOSA, INC.
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Dates
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Enumeration Date | 01/27/2020
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Last Update Date | 08/30/2021
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Provider Practice Location Address
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Address Line | 459 LEWIS STREET
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City | PAGOSA SPRINGS
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State | CO
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Zip | 81147
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Country | US
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Telephone | 970-398-1636
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 5913
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City | PAGOSA SPRINGS
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State | CO
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Zip | 81147-5913
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Country | US
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Telephone | 970-398-1636
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Fax |
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | KATELYN SIMMONS
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Credential |
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Telephone | 719-314-7383
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 373H00000X
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Taxonomy Name | Day Training/Habilitation Specialist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 320600000X
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Taxonomy Name | Intellectual and/or Developmental Disabilities Residential Treatment Facility
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 320900000X
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Taxonomy Name | Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 343900000X
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Taxonomy Name | Non-emergency Medical Transport (VAN)
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 251C00000X
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Taxonomy Name | Developmentally Disabled Services Day Training Agency
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License Number |
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License Number State |
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