Provider Demographics
NPI:1497482590
Name:HOMEWARD PIKES PEAK
Entity Type:Organization
Organization Name:HOMEWARD PIKES PEAK
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:FREDI
Authorized Official - Middle Name:SHAE
Authorized Official - Last Name:PROCHODA
Authorized Official - Suffix:
Authorized Official - Credentials:DNP, MSN, FNP, PMHNP
Authorized Official - Phone:303-881-8598
Mailing Address - Street 1:325 N EL PASO ST
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80903-3115
Mailing Address - Country:US
Mailing Address - Phone:719-473-5557
Mailing Address - Fax:719-473-6442
Practice Address - Street 1:701 E BOULDER ST
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80903-3103
Practice Address - Country:US
Practice Address - Phone:719-473-5557
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HOMEWARD PIKES PEAK
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-08-08
Last Update Date:2022-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health