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General NPI Number Information
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NPI Number | 1396235511
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Entity Type | Organization
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Legal Business Name | E DAWN MARTIN CACIII LLC
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Dates
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Enumeration Date | 05/14/2018
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Last Update Date | 09/14/2022
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Provider Practice Location Address
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Address Line | 140 S PARKSIDE DR
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City | COLORADO SPRINGS
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State | CO
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Zip | 80910-3129
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Country | US
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Telephone | 719-358-7338
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Fax | 844-273-2340
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Provider Business Mailing Address
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Address Line | 140 S PARKSIDE DR
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City | COLORADO SPRINGS
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State | CO
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Zip | 80910-3129
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Country | US
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Telephone | 719-358-7338
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Fax | 844-273-2340
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Authorized Official
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Title or Position | OWNER
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Name | MRS. ELIZABETH DAWN MARTIN
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Credential | CACIII
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Telephone | 719-930-8801
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR0405X
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Taxonomy Name | Substance Use Disorder Rehabilitation Clinic/Center
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License Number |
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License Number State |
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