Provider Demographics
NPI:1114137569
Name:PIKES PEAK PATHWAYS, PIKES PEAK BOCES
Entity Type:Organization
Organization Name:PIKES PEAK PATHWAYS, PIKES PEAK BOCES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:DENISE
Authorized Official - Middle Name:
Authorized Official - Last Name:HARTMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MED
Authorized Official - Phone:719-635-6333
Mailing Address - Street 1:828 WOOTEN RD
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80915-3520
Mailing Address - Country:US
Mailing Address - Phone:719-635-6333
Mailing Address - Fax:719-380-6249
Practice Address - Street 1:828 WOOTEN RD
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80915-3520
Practice Address - Country:US
Practice Address - Phone:719-635-6333
Practice Address - Fax:719-380-6249
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-23
Last Update Date:2008-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty