Organization
CENTENNIAL COMMUNITY CARE, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SHEA ENOS (OWNER)
(940) 597-5382
Entity
Organization
Contact information
Practice address
545 E PIKES PEAK AVE, COLORADO SPRINGS, CO 80903-3637
(940) 597-5382
Mailing address
101 CEMETERY RD, AURORA, TX 76078-4503
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
—
—
101YM0800X
Mental Health Counselor
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000000000
—
CO
Enumeration date
01/27/2016
Last updated
01/27/2016
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