Organization
BOONE GUEST HOME
Active
Organization
BOONE GUEST HOME
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JONNA K MCCLURE (OWNER/DIRECTOR)
(719) 564-0163
Entity
Organization
Contact information
Practice address
1339 S PUEBLO BLVD, PUEBLO, CO 81005-1686
(719) 564-0163
(719) 564-0193
Mailing address
1339 S PUEBLO BLVD, PUEBLO, CO 81005-1686
(719) 564-0163
(719) 564-0193
Taxonomy
Speciality
Code
Description
License number
State
251C00000X
Developmentally Disabled Services Day Training Agency
—
—
253J00000X
Foster Care Agency
—
—
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
Primary
050615
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
52880711
—
CO
05
—
84622814
—
CO
Enumeration date
04/18/2011
Last updated
11/19/2015
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