Organization
P.A.L'S ACF & DAY PROGRAM
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LISA WALDERO (OWNER)
(719) 543-4108
Entity
Organization
Contact information
Practice address
232 BROADWAY AVE, PUEBLO, CO 81004-2102
(719) 543-4108
Mailing address
232 BROADWAY AVE, PUEBLO, CO 81004-2102
Taxonomy
Speciality
Code
Description
License number
State
3104A0625X
Assisted Living Facility (Mental Illness)
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
04141875
—
CO
Enumeration date
04/18/2008
Last updated
04/18/2008
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