| NPI | 1952908840 |
|---|---|
| Doing Business As | MARC PUEBLO |
| Entity Type | Organization |
| Authorized Contact | JASON CHIPPEAUX President/CEO 719-545-2746 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) |
| Additional Taxonomies | 261QM0850X Clinic/Center, Adult Mental Health |
| 261QR0405X Clinic/Center, Rehabilitation, Substance Use Disorder | |
| Enumeration Date | 2020-10-05 |
| Last Update Date | 2024-08-14 |