Provider Demographics
NPI:1306408216
Name:PROVIDENCE RECOVERY SERVICE OF COLORADO LLC
Entity Type:Organization
Organization Name:PROVIDENCE RECOVERY SERVICE OF COLORADO LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:TINA
Authorized Official - Middle Name:RENE
Authorized Official - Last Name:VEST
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:662-625-7111
Mailing Address - Street 1:PO BOX 895
Mailing Address - Street 2:
Mailing Address - City:CRAIG
Mailing Address - State:CO
Mailing Address - Zip Code:81626-0895
Mailing Address - Country:US
Mailing Address - Phone:970-878-9958
Mailing Address - Fax:
Practice Address - Street 1:390 YAMPA BOULEVARD
Practice Address - Street 2:
Practice Address - City:CRAIG
Practice Address - State:CO
Practice Address - Zip Code:81625-2600
Practice Address - Country:US
Practice Address - Phone:709-824-5433
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-07-01
Last Update Date:2020-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty