Organization
STATE OF GRACE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ROBERT R MAES (CLINICAL DIRECTOR)
(719) 569-7909
Entity
Organization
Contact information
Practice address
720 N MAIN ST STE 330, PUEBLO, CO 81003-3047
(719) 569-7909
Mailing address
720 N MAIN ST STE 330, PUEBLO, CO 81003-3047
(719) 569-7909
Taxonomy
Speciality
Code
Description
License number
State
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
Primary
—
—
Other
Enumeration date
10/26/2020
Last updated
04/15/2021
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