Organization
MI CASA TRANSITIONAL SERVICES INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LISA M PAYNE COTA/L (OFFICIAL AGENT)
(719) 214-4755
Entity
Organization
Contact information
Practice address
1611 CRESTMOOR DR, PUEBLO, CO 81001-2727
(719) 214-4755
Mailing address
1611 CRESTMOOR DR, PUEBLO, CO 81001-2727
(719) 214-4755
Taxonomy
Speciality
Code
Description
License number
State
175T00000X
Peer Specialist
0000444
CO
251B00000X
Case Management Agency
Primary
—
—
251S00000X
Community/Behavioral Health Agency
—
—
Other
Enumeration date
11/29/2017
Last updated
01/23/2020
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