Wcmhc-adad | |
3225 Independence Rd Canon City CO 81212-9380 | |
(719) 275-2351 | |
(719) 269-9386 |
Full Name | Wcmhc-adad |
---|---|
Speciality | Clinic/center - Mental Health (including Community Mental Health Center) |
Location | 3225 Independence Rd, Canon City, Colorado |
Authorized Official Name and Position | Mandy Jo Kaisner (CHIEF EXECUTIVE OFFICER) |
Authorized Official Contact | 7192752351 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
---|---|
Wcmhc-adad 3225 Independence Rd Canon City CO 81212-9380 Ph: (719) 275-2351 | Wcmhc-adad 3225 Independence Rd Canon City CO 81212-9380 Ph: (719) 275-2351 |
NPI Number | 1245518968 |
---|---|
Provider Enumeration Date | 07/29/2011 |
Last Update Date | 05/08/2024 |
Certification Date | 05/08/2024 |
Identifier | Type | State | Issuer |
---|---|---|---|
1245518968 | NPI | - | NPPES |
80125328 | Medicaid | CO |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | (* (Not Available)) | Primary |
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