# PROVIDENCE RECOVERY SERVICE OF COLORADO LLC

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

## Provider details

- **NPI number:** 1306408216
- **Authorized official:** MRS. TINA RENE VEST (BILLING DIRECTOR)
- **Authorized official phone:** (662) 625-7111

## Contact information

- **Practice address:** 390 YAMPA BOULEVARD, CRAIG, CO 81625-2600
- **Practice address phone:** (709) 824-5433
- **Mailing address:** PO BOX 895, CRAIG, CO 81626-0895
- **Mailing address phone:** (970) 878-9958

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 101YA0400X | Addiction (Substance Use Disorder) Counselor | — | NULL | Yes |
| 101YA0400X | Addiction (Substance Use Disorder) Counselor | — | — | Yes |

## Other

- **Enumeration date:** 07/01/2019
- **Last updated:** 02/26/2020