Provider Demographics
NPI:1225373418
Name:PUEBLO CARE AND REHAB
Entity Type:Organization
Organization Name:PUEBLO CARE AND REHAB
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CERTIFIED OT ASSISTANT/COTA
Authorized Official - Prefix:
Authorized Official - First Name:KAREN WILSON
Authorized Official - Middle Name:
Authorized Official - Last Name:WILSON
Authorized Official - Suffix:
Authorized Official - Credentials:CERTIFICATION
Authorized Official - Phone:719-544-4408
Mailing Address - Street 1:2611 JONES AVE
Mailing Address - Street 2:
Mailing Address - City:PUEBLO
Mailing Address - State:CO
Mailing Address - Zip Code:81004-2650
Mailing Address - Country:US
Mailing Address - Phone:719-544-4408
Mailing Address - Fax:719-566-1960
Practice Address - Street 1:2611 JONES AVE
Practice Address - Street 2:
Practice Address - City:PUEBLO
Practice Address - State:CO
Practice Address - Zip Code:81004-2650
Practice Address - Country:US
Practice Address - Phone:719-544-4408
Practice Address - Fax:719-566-1960
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-11-29
Last Update Date:2017-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1401044314000000X, 385H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
No385H00000XRespite Care FacilityRespite Care