# BRAD'S HOUSE MESA RIDGE LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1235973660
- **Authorized official:** PATRICK HAGGARD (BILLING MANAGER)
- **Authorized official phone:** (719) 641-6051

## Contact information

- **Practice address:** 646 DEXTER ST, COLORADO SPRINGS, CO 80911-2542
- **Practice address phone:** (719) 204-4548
- **Mailing address:** 14960 WOODCARVER RD, COLORADO SPRINGS, CO 80921-2370

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 322D00000X | Emotionally Disturbed Childrens' Residential Treatment Facility | — | — | Yes |

## Other

- **Enumeration date:** 06/20/2024
- **Last updated:** 04/25/2025