Provider Demographics
NPI:1336365600
Name:PUEBLO COUNTY
Entity Type:Organization
Organization Name:PUEBLO COUNTY
Other - Org Name:DEPT OF SOCIAL SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF FINANCE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:SHARON
Authorized Official - Middle Name:J
Authorized Official - Last Name:ELLIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:719-583-6179
Mailing Address - Street 1:212 W 12TH ST
Mailing Address - Street 2:
Mailing Address - City:PUEBLO
Mailing Address - State:CO
Mailing Address - Zip Code:81003-2975
Mailing Address - Country:US
Mailing Address - Phone:719-583-6179
Mailing Address - Fax:719-583-6174
Practice Address - Street 1:212 W 12TH ST
Practice Address - Street 2:
Practice Address - City:PUEBLO
Practice Address - State:CO
Practice Address - Zip Code:81003-2975
Practice Address - Country:US
Practice Address - Phone:719-583-6179
Practice Address - Fax:719-583-6174
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO251K00000X
343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered251K00000XAgenciesPublic Health or Welfare
Not Answered343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO06200513Medicaid
CO09000514Medicaid