# BRAD'S HOUSE PUEBLO

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

## Provider details

- **NPI number:** 1437845690
- **Authorized official:** SAMANTHA THOMPSON (HR/BILLING DIRECTOR)
- **Authorized official phone:** (719) 639-3776

## Contact information

- **Practice address:** 422 BROADWAY AVE, PUEBLO, CO 81004-2128
- **Practice address phone:** (719) 639-3776
- **Mailing address:** 14960 WOODCARVER RD \# 106, COLORADO SPRINGS, CO 80921-2370
- **Mailing address phone:** (719) 639-3776

## Taxonomy

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

## Other

- **Enumeration date:** 04/12/2023
- **Last updated:** 04/12/2023