Provider Demographics
NPI:1740052844
Name:PEER COACH ACADEMY COLORADO
Entity type:Organization
Organization Name:PEER COACH ACADEMY COLORADO
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ROD
Authorized Official - Middle Name:E
Authorized Official - Last Name:RUSHING
Authorized Official - Suffix:
Authorized Official - Credentials:CAS, CPFS
Authorized Official - Phone:720-435-5320
Mailing Address - Street 1:2614 W PIKES PEAK AVE
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80904-3040
Mailing Address - Country:US
Mailing Address - Phone:720-435-5320
Mailing Address - Fax:
Practice Address - Street 1:8395 CLIFTON DR
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80920-8065
Practice Address - Country:US
Practice Address - Phone:800-604-8978
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PEER COACH ACADEMY COLORADO INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2023-10-23
Last Update Date:2024-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness