Organization
PUEBLO DIVERSIFIED INDUSTRIES, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
BRYANA BURNS (CFO)
(719) 564-0000
Entity
Organization
Contact information
Practice address
2828 GRANADA BLVD, PUEBLO, CO 81005-3104
(719) 564-0000
Mailing address
2828 GRANADA BLVD, PUEBLO, CO 81005-3104
(719) 564-0000
Taxonomy
Speciality
Code
Description
License number
State
251C00000X
Developmentally Disabled Services Day Training Agency
Primary
—
—
251S00000X
Community/Behavioral Health Agency
—
—
253Z00000X
In Home Supportive Care Agency
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
09142183
—
CO
Enumeration date
04/27/2016
Last updated
04/28/2016
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