MEDICARE: PEER COACH ACADEMY COLORADO

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	261QR0405X	Substance Use Disorder Rehabilitation Clinic/Center
2	1041C0700X	Clinical Social Worker
3	251S00000X	Community/Behavioral Health Agency

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1023620440
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PEER COACH ACADEMY COLORADO

Provider Business Mailing Address
First Line	:	411 S CASCADE AVE STE 100
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80903-3811
Country	:	US
Telephone Number	:	800-604-8978
Fax Number	:

Provider Business Practice Location Address
First Line	:	411 S CASCADE AVE STE 100
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80903-3811
Country	:	US
Telephone Number	:	800-604-8978
Fax Number	:

Authorized Official
Title or Position	:	DIRECTOR
Name	:	ROD E RUSHING
Credential	:	CACIII
Telephone Number	:	720-435-5320

Provider Enumeration Date	:	08/18/2020
Last Update Date	:	12/18/2025

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