Provider Demographics
NPI:1225207400
Name:SOARING EAGLES CENTER FOR AUTISM
Entity Type:Organization
Organization Name:SOARING EAGLES CENTER FOR AUTISM
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:W
Authorized Official - Last Name:COLVIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:719-547-8803
Mailing Address - Street 1:PO BOX 7878
Mailing Address - Street 2:
Mailing Address - City:PUEBLO WEST
Mailing Address - State:CO
Mailing Address - Zip Code:81007-0878
Mailing Address - Country:US
Mailing Address - Phone:719-547-8803
Mailing Address - Fax:719-547-8806
Practice Address - Street 1:125 W PALMER LAKE DR
Practice Address - Street 2:
Practice Address - City:PUEBLO WEST
Practice Address - State:CO
Practice Address - Zip Code:81007-2876
Practice Address - Country:US
Practice Address - Phone:719-547-8803
Practice Address - Fax:719-547-8806
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-21
Last Update Date:2018-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO34666101YM0800X, 251S00000X
CO1-17-30000103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No251S00000XAgenciesCommunity/Behavioral HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO80986226Medicaid