Organization
BRAD'S HOUSE PUEBLO
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SAMANTHA THOMPSON (HR/BILLING DIRECTOR)
(719) 639-3776
Entity
Organization
Contact information
Practice address
422 BROADWAY AVE, PUEBLO, CO 81004-2128
(719) 639-3776
Mailing address
14960 WOODCARVER RD # 106, COLORADO SPRINGS, CO 80921-2370
(719) 639-3776
Taxonomy
Speciality
Code
Description
License number
State
322D00000X
Emotionally Disturbed Childrens' Residential Treatment Facility
Primary
—
—
Other
Enumeration date
04/12/2023
Last updated
04/12/2023
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