Provider Demographics
NPI:1093580193
Name:JACE'S PLACE LIMITED LIABILITY CO.
Entity Type:Organization
Organization Name:JACE'S PLACE LIMITED LIABILITY CO.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-FOUNDER
Authorized Official - Prefix:
Authorized Official - First Name:MONICA
Authorized Official - Middle Name:
Authorized Official - Last Name:MARTINEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:719-251-5568
Mailing Address - Street 1:330 LAKE AVE STE 210
Mailing Address - Street 2:
Mailing Address - City:PUEBLO
Mailing Address - State:CO
Mailing Address - Zip Code:81004-2386
Mailing Address - Country:US
Mailing Address - Phone:719-251-5568
Mailing Address - Fax:
Practice Address - Street 1:330 LAKE AVE STE 210
Practice Address - Street 2:
Practice Address - City:PUEBLO
Practice Address - State:CO
Practice Address - Zip Code:81004-2386
Practice Address - Country:US
Practice Address - Phone:719-251-5568
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-11-17
Last Update Date:2023-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services