Provider Demographics
NPI:1043759541
Name:PUEBLO REGIONAL CENTER
Entity Type:Organization
Organization Name:PUEBLO REGIONAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:
Authorized Official - Last Name:BOWMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:719-585-4042
Mailing Address - Street 1:270 W JOHN POWELL BLVD
Mailing Address - Street 2:
Mailing Address - City:PUEBLO
Mailing Address - State:CO
Mailing Address - Zip Code:81007-1775
Mailing Address - Country:US
Mailing Address - Phone:719-585-4001
Mailing Address - Fax:719-585-4030
Practice Address - Street 1:614 S CLARION DR
Practice Address - Street 2:
Practice Address - City:PUEBLO
Practice Address - State:CO
Practice Address - Zip Code:81007-1524
Practice Address - Country:US
Practice Address - Phone:719-585-4001
Practice Address - Fax:719-585-4030
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-16
Last Update Date:2024-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities