Organization
PUEBLO COMMUNITY CONNECTIONS INC II
Active
Organization subpart
No
Provider details
NPI number
Authorized official
THOMAS LAVINE (OWNER/OPERATOR)
(719) 544-2122
Entity
Organization
Contact information
Practice address
3913 SANDALWOOD LN, PUEBLO, CO 81005-2586
(719) 544-2122
Mailing address
3913 SANDALWOOD LN, PUEBLO, CO 81005-2586
(719) 544-2122
Taxonomy
Speciality
Code
Description
License number
State
251C00000X
Developmentally Disabled Services Day Training Agency
—
CO
253Z00000X
In Home Supportive Care Agency
Primary
—
CO
Other
Enumeration date
01/25/2017
Last updated
01/25/2017
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