Provider Demographics
NPI:1598002131
Name:HOMEWARD PIKES PEAK
Entity Type:Organization
Organization Name:HOMEWARD PIKES PEAK
Other - Org Name:HARBOR HOUSE CLINICAL SERVCIES
Other - Org Type:Other Name
Authorized Official - Title/Position:CLINICAL ADMIN
Authorized Official - Prefix:
Authorized Official - First Name:LYNNETTE
Authorized Official - Middle Name:
Authorized Official - Last Name:CARMICHAEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:719-473-5557
Mailing Address - Street 1:2010 E BIJOU ST
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80909-5819
Mailing Address - Country:US
Mailing Address - Phone:719-473-5557
Mailing Address - Fax:719-473-6442
Practice Address - Street 1:2010 E BIJOU ST
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80909-5819
Practice Address - Country:US
Practice Address - Phone:719-473-5557
Practice Address - Fax:719-473-6442
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-15
Last Update Date:2021-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO161401251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO42125251Medicaid
CO161401OtherOLD LICENSE NUMBER