Organization
GOLDEN GATE MANOR
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. MARK JOHN HARRIMAN I LIC PSY TECH-MENTALL (OWNER)
(719) 564-0344
Entity
Organization
Contact information
Practice address
606 W ABRIENDO AVE, PUEBLO, CO 81004-1545
(719) 583-9132
Mailing address
606 W ABRIENDO AVE, PUEBLO, CO 81004-1545
Taxonomy
Speciality
Code
Description
License number
State
310400000X
Assisted Living Facility
Primary
AL0183
CO
Other
Enumeration date
04/11/2007
Last updated
07/14/2008
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