PROVIDENCE RECOVERY SERVICE OF COLORADO LLC NPI 1306408216

NPI Information

PROVIDENCE RECOVERY SERVICE OF COLORADO LLC is an addiction (substance use disorder) counselor in Craig, CO. PROVIDENCE RECOVERY SERVICE OF COLORADO LLC NPI is 1306408216. The provider is registered as an organization entity type and is a single specialty group.

The provider's business location address is:

390 YAMPA BOULEVARD
CRAIG, CO
ZIP 81625-600
Phone: (709) 824-5433

The provider's authorized official is Tina Rene Vest .
The authorized official title is Billing Director and has the following contact phone number (662) 625-7111.

The CLIA number assigned to this NPI record is 06D2169562 - other with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 7/1/2019 and was last updated on 2/26/2020.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

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