| Providence Recovery Service Of Colorado Llc | |
|
390 Yampa Boulevard Craig CO 81625-2600 | |
| (709) 824-5433 | |
| Not Available |
| Full Name | Providence Recovery Service Of Colorado Llc |
|---|---|
| Speciality | Counselor - Addiction (substance Use Disorder) |
| Location | 390 Yampa Boulevard, Craig, Colorado |
| Authorized Official Name and Position | Tina Rene Vest (BILLING DIRECTOR) |
| Authorized Official Contact | 6626257111 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Providence Recovery Service Of Colorado Llc Po Box 895 Craig CO 81626-0895 Ph: (970) 878-9958 | Providence Recovery Service Of Colorado Llc 390 Yampa Boulevard Craig CO 81625-2600 Ph: (709) 824-5433 |
| NPI Number | 1306408216 |
|---|---|
| Provider Enumeration Date | 07/01/2019 |
| Last Update Date | 02/26/2020 |
| Certification Date | 02/26/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1306408216 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YA0400X | Counselor - Addiction (substance Use Disorder) | (* (Not Available)) | Primary |
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