Provider Demographics
NPI:1306184056
Name:AFFORDABLE HEALTH CLINIC, LLC
Entity Type:Organization
Organization Name:AFFORDABLE HEALTH CLINIC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:DAWN
Authorized Official - Middle Name:LESLIE
Authorized Official - Last Name:EVERT
Authorized Official - Suffix:
Authorized Official - Credentials:NP-C
Authorized Official - Phone:719-924-9021
Mailing Address - Street 1:900 INDIANA AVE ST D
Mailing Address - Street 2:
Mailing Address - City:PUEBLO
Mailing Address - State:CO
Mailing Address - Zip Code:81004-7503
Mailing Address - Country:US
Mailing Address - Phone:719-924-9021
Mailing Address - Fax:719-924-9166
Practice Address - Street 1:900 INDIANA AVE ST D
Practice Address - Street 2:
Practice Address - City:PUEBLO
Practice Address - State:CO
Practice Address - Zip Code:81004-8100
Practice Address - Country:US
Practice Address - Phone:719-924-9021
Practice Address - Fax:719-924-9166
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-30
Last Update Date:2020-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO81123261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center