Provider Demographics
NPI:1598890238
Name:PARTNERSHIP FOR PROGRESS LLC
Entity Type:Organization
Organization Name:PARTNERSHIP FOR PROGRESS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:
Authorized Official - Last Name:CARRICA
Authorized Official - Suffix:III
Authorized Official - Credentials:CACII
Authorized Official - Phone:719-384-5446
Mailing Address - Street 1:PO BOX 452
Mailing Address - Street 2:
Mailing Address - City:SWINK
Mailing Address - State:CO
Mailing Address - Zip Code:81077-0452
Mailing Address - Country:US
Mailing Address - Phone:719-853-6329
Mailing Address - Fax:
Practice Address - Street 1:711 BARNES AVE
Practice Address - Street 2:
Practice Address - City:LA JUNTA
Practice Address - State:CO
Practice Address - Zip Code:81050-2138
Practice Address - Country:US
Practice Address - Phone:719-384-5446
Practice Address - Fax:719-384-5672
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1587-01261QR0405X
CO1587-02261QR0405X
CO1587-03261QR0405X
CO1587-04261QR0405X
CO1587-05261QR0405X
CO1587-06261QR0405X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO25106848Medicaid
CO55708731Medicaid
CO06252052Medicaid
CO02829347Medicaid
CO86730754Medicaid
CO79106331Medicaid