Provider Demographics
NPI:1740409812
Name:NEWPATH BEHAVIORAL REHABILITATION CENTER
Entity type:Organization
Organization Name:NEWPATH BEHAVIORAL REHABILITATION CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:SALVADOR
Authorized Official - Middle Name:
Authorized Official - Last Name:CRUZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:719-543-6988
Mailing Address - Street 1:PO BOX 568
Mailing Address - Street 2:
Mailing Address - City:PUEBLO
Mailing Address - State:CO
Mailing Address - Zip Code:81002-0568
Mailing Address - Country:US
Mailing Address - Phone:719-296-5840
Mailing Address - Fax:719-542-0746
Practice Address - Street 1:128 S UNION AVE
Practice Address - Street 2:SUITE C
Practice Address - City:PUEBLO
Practice Address - State:CO
Practice Address - Zip Code:81003-3443
Practice Address - Country:US
Practice Address - Phone:719-543-6988
Practice Address - Fax:719-542-1290
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-25
Last Update Date:2008-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO234032084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CR19308OtherBCBS
CO01234038Medicaid
DB7127OtherRR MEDICARE
CO01234038Medicaid
CO05466Medicare UPIN