Organization
PUEBLO COMMUNITY HEALTH CENTER, INC
Active
Other names
Centennial HS SBWC
Organization subpart
No
Provider details
NPI number
Authorized official
DONALD MOORE (CHIEF EXECUTIVE OFFICER)
(719) 543-8711
Entity
Organization
Contact information
Practice address
2525 MOUNTVIEW DR, PUEBLO, CO 81008-1431
(719) 543-8711
Mailing address
110 E ROUTT AVE, PUEBLO, CO 81004-2117
(719) 543-8718
Taxonomy
Speciality
Code
Description
License number
State
261QF0400X
Federally Qualified Health Center (FQHC)
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
05638275
—
CO
Enumeration date
04/18/2016
Last updated
04/18/2016
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