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General NPI Number Information
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NPI Number | 1457276396
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Entity Type | Organization
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Legal Business Name | ASSISTED LIVING AT PUEBLO, LLC
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Dates
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Enumeration Date | 08/11/2026
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Last Update Date | 08/11/2026
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Provider Practice Location Address
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Address Line | 544 E. ABRIENDO AVENUE
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City | PUEBLO
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State | CO
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Zip | 81004-2389
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Country | US
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Telephone | 719-569-7990
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Fax | 719-569-7945
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Provider Business Mailing Address
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Address Line | P.O. BOX 274
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City | PARKER
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State | CO
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Zip | 80134-8998
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Country | US
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Telephone | 720-635-4734
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Fax | 720-420-1322
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MELANY S WONG
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Credential |
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Telephone | 720-635-4734
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3104A0625X
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Taxonomy Name | Assisted Living Facility (Mental Illness)
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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 | 3104A0630X
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Taxonomy Name | Assisted Living Facility (Behavioral Disturbances)
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License Number |
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License Number State |
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