MEDICARE: COLORADO SPRINGS RECOVERY CENTER, LLC

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	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)
2	324500000X	Substance Abuse Rehabilitation Facility

General Provider Information

NPI Number	:	1952278962
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COLORADO SPRINGS RECOVERY CENTER, LLC

Provider Business Mailing Address
First Line	:	15813 72ND AVE FL 2
Second Line	:
City	:	FLUSHING
State	:	NY
Zip	:	11365-4100
Country	:	US
Telephone Number	:	716-819-0392
Fax Number	:	716-819-0392

Provider Business Practice Location Address
First Line	:	1855 AEROPLAZA DR
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80916-4204
Country	:	US
Telephone Number	:	719-623-1333
Fax Number	:	719-623-1333

Authorized Official
Title or Position	:	CEO
Name	:	CHRISTOPHER FOSTER
Credential	:
Telephone Number	:	716-819-0392

Provider Enumeration Date	:	10/22/2025
Last Update Date	:	01/23/2026

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