Provider Demographics
NPI:1609574532
Name:PURE BALANCE HEALTH SYSTEMS
Entity Type:Organization
Organization Name:PURE BALANCE HEALTH SYSTEMS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOCIAL WORKER, CO-OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NINA
Authorized Official - Middle Name:ELIZABETH
Authorized Official - Last Name:GEOFFROY-SUPPES
Authorized Official - Suffix:
Authorized Official - Credentials:MSW, SWC
Authorized Official - Phone:209-809-1517
Mailing Address - Street 1:1240 DE REAMER CIR
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80915-2202
Mailing Address - Country:US
Mailing Address - Phone:719-649-5343
Mailing Address - Fax:
Practice Address - Street 1:1240 DE REAMER CIR
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80915-2202
Practice Address - Country:US
Practice Address - Phone:719-649-5343
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-02-20
Last Update Date:2023-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health