Provider Demographics
NPI:1538791330
Name:SOARING EAGLES CENTER FOR AUTISM
Entity type:Organization
Organization Name:SOARING EAGLES CENTER FOR AUTISM
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:W
Authorized Official - Last Name:COLVIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:719-547-8803
Mailing Address - Street 1:PO BOX 7878
Mailing Address - Street 2:
Mailing Address - City:PUEBLO WEST
Mailing Address - State:CO
Mailing Address - Zip Code:81007-0878
Mailing Address - Country:US
Mailing Address - Phone:719-547-8803
Mailing Address - Fax:719-547-8806
Practice Address - Street 1:125 W PALMER LAKE DR
Practice Address - Street 2:
Practice Address - City:PUEBLO WEST
Practice Address - State:CO
Practice Address - Zip Code:81007-2876
Practice Address - Country:US
Practice Address - Phone:719-547-8803
Practice Address - Fax:719-547-8806
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SOARING EAGLES CENTER FOR AUTISM
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-02-10
Last Update Date:2020-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health