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General NPI Number Information
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NPI Number | 1497024590
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Entity Type | Organization
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Legal Business Name | COMCOR, INC.
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Dates
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Enumeration Date | 12/19/2011
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Last Update Date | 12/19/2011
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Provider Practice Location Address
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Address Line | 3615 ROBERTS RD
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City | COLORADO SPRINGS
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State | CO
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Zip | 80907-5301
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Country | US
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Telephone | 719-473-4460
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Fax |
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Provider Business Mailing Address
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Address Line | 3615 ROBERTS RD
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City | COLORADO SPRINGS
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State | CO
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Zip | 80907-5301
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Country | US
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Telephone | 719-473-4460
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Fax |
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Authorized Official
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Title or Position | ADMINISTRATIVE SUPPORT MANAGER
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Name | SUSAN KUIPER
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Credential |
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Telephone | 719-473-4460
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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 | 1421-00
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License Number State | CO
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