Provider Demographics
NPI:1275925240
Name:CARMINA BLASKO, LLC
Entity Type:Organization
Organization Name:CARMINA BLASKO, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CARMINA
Authorized Official - Middle Name:
Authorized Official - Last Name:BLASKO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:719-650-3921
Mailing Address - Street 1:6309 TENDERFOOT DR
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80923-7401
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5585 ERINDALE DR
Practice Address - Street 2:SUITE 201
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80918-6737
Practice Address - Country:US
Practice Address - Phone:719-650-3921
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-02-26
Last Update Date:2015-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO12348251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health