Provider Demographics
NPI:1376273003
Name:CBLG RESIDENTIAL SERVICES
Entity Type:Organization
Organization Name:CBLG RESIDENTIAL SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:HR
Authorized Official - Prefix:
Authorized Official - First Name:JACEY
Authorized Official - Middle Name:
Authorized Official - Last Name:RICHARDS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:719-466-4809
Mailing Address - Street 1:2920 N ACADEMY BLVD STE 210
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80917-5369
Mailing Address - Country:US
Mailing Address - Phone:719-466-4809
Mailing Address - Fax:719-368-8399
Practice Address - Street 1:2920 N ACADEMY BLVD STE 210
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80917-5369
Practice Address - Country:US
Practice Address - Phone:719-466-4809
Practice Address - Fax:719-368-8399
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ELIZABETH RASZKA CONSULTING
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-06-15
Last Update Date:2022-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Multi-Specialty