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General NPI Number Information
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NPI Number | 1538791330
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Entity Type | Organization
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Legal Business Name | SOARING EAGLES CENTER FOR AUTISM
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Dates
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Enumeration Date | 02/10/2020
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Last Update Date | 02/10/2020
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Provider Practice Location Address
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Address Line | 125 W PALMER LAKE DR
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City | PUEBLO WEST
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State | CO
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Zip | 81007-2876
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Country | US
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Telephone | 719-547-8803
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Fax | 719-547-8806
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Provider Business Mailing Address
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Address Line | PO BOX 7878
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City | PUEBLO WEST
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State | CO
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Zip | 81007-0878
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Country | US
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Telephone | 719-547-8803
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Fax | 719-547-8806
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | KAREN W. COLVIN
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Credential | MD
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Telephone | 719-547-8803
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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