Organization
PUEBLO COMMUNITY HEALTH CENTER INC
Active
Organization
PUEBLO COMMUNITY HEALTH CENTER INC
Active
Other names
Central High School SBWC
Organization subpart
No
Provider details
NPI number
Authorized official
DONALD MOORE (CEO)
(719) 543-8711
Entity
Organization
Contact information
Practice address
216 E ORMAN AVE, PUEBLO, CO 81004-2144
(719) 543-8711
(719) 543-0171
Mailing address
110 E ROUTT AVE, PUEBLO, CO 81004-2117
(719) 543-8711
(719) 543-5340
Taxonomy
Speciality
Code
Description
License number
State
261QF0400X
Federally Qualified Health Center (FQHC)
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
04257871
—
CO
Enumeration date
10/26/2012
Last updated
06/11/2021
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