MEDICARE: ELK MEADOW ENDURING CONNECTIONS, INC.

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163WA0400X	Addiction (Substance Use Disorder) Registered Nurse

General Provider Information

NPI Number	:	1427916253
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ELK MEADOW ENDURING CONNECTIONS, INC.

Provider Business Mailing Address
First Line	:	PO BOX 62359
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80962-2359
Country	:	US
Telephone Number	:	719-452-0393
Fax Number	:

Provider Business Practice Location Address
First Line	:	685 CITADEL DR E STE 510
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80909-5372
Country	:	US
Telephone Number	:	719-452-0393
Fax Number	:

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	MITA M JOHNSON
Credential	:	EDD, LPC, LMFT, LAC
Telephone Number	:	719-452-0393

Provider Enumeration Date	:	01/12/2026
Last Update Date	:	01/12/2026

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