Provider Demographics
NPI:1578340501
Name:PEER COACH ACADEMY COLORADO
Entity Type:Organization
Organization Name:PEER COACH ACADEMY COLORADO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:DELSIGNORE
Authorized Official - Suffix:
Authorized Official - Credentials:ALR ADMINISTRATOR
Authorized Official - Phone:719-581-0857
Mailing Address - Street 1:2509 N CASCADE AVE
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80907-6742
Mailing Address - Country:US
Mailing Address - Phone:719-581-0857
Mailing Address - Fax:
Practice Address - Street 1:2509 N CASCADE AVE
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80907-6742
Practice Address - Country:US
Practice Address - Phone:719-581-0857
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PEER COACH ACADEMY RENAISSANCE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2023-09-13
Last Update Date:2023-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3104A0625XNursing & Custodial Care FacilitiesAssisted Living FacilityAssisted Living, Mental Illness