Provider Demographics
NPI:1346959582
Name:PURPLE MOUNTAIN RECOVERY INC
Entity Type:Organization
Organization Name:PURPLE MOUNTAIN RECOVERY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:
Authorized Official - Last Name:MOSHER-RAMIREZ
Authorized Official - Suffix:
Authorized Official - Credentials:CPFS, NCPRSS, IARCP
Authorized Official - Phone:719-445-0621
Mailing Address - Street 1:3225 AUSTIN BLUFFS PKWY STE 100
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80918-5768
Mailing Address - Country:US
Mailing Address - Phone:719-445-0621
Mailing Address - Fax:
Practice Address - Street 1:3225 AUSTIN BLUFFS PKWY STE 100
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80918-5768
Practice Address - Country:US
Practice Address - Phone:719-445-0621
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-11-16
Last Update Date:2024-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No261QR0800XAmbulatory Health Care FacilitiesClinic/CenterRecovery Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO9000215817Medicaid