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General NPI Number Information
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NPI Number | 1295903045
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Entity Type | Organization
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Legal Business Name | SOUTHERN COLORADO ADDICTION RECOVERY CENTER
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Dates
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Enumeration Date | 02/14/2008
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Last Update Date | 02/14/2008
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Provider Practice Location Address
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Address Line | 5250 PIKES PEAK HWY
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City | CASCADE
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State | CO
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Zip | 80809-1110
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Country | US
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Telephone | 719-217-5082
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Fax |
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Provider Business Mailing Address
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Address Line | 225 N WEBER ST
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City | COLORADO SPRINGS
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State | CO
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Zip | 80903-1309
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Country | US
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Telephone | 719-508-2217
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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 | MR. MICHAEL J. MCKELVEY
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Credential | ADMINISTRATOR
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Telephone | 719-217-5082
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 324500000X
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Taxonomy Name | Substance Abuse Rehabilitation Facility
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License Number |
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License Number State |
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