Organization
PREMIUM DIRECT CARE PROVIDERS INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JOANN MADRID (PRESIDENT)
(719) 543-3600
Entity
Organization
Contact information
Practice address
1612 BONFORTE BLVD, PUEBLO, CO 81001-1603
(719) 543-3600
Mailing address
1612 BONFORTE BLVD, PUEBLO, CO 81001-1603
Taxonomy
Speciality
Code
Description
License number
State
261QD1600X
Developmental Disabilities Clinic/Center
Primary
—
—
Other
Enumeration date
12/07/2015
Last updated
12/07/2015
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