PEACEFUL SPIRIT/SUCAP (NPI# 1104069764) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1104069764 |
| Entity Type | Organization |
| Organization Name | PEACEFUL SPIRIT/SUCAP |
| Practice Address |
296 Mouache Drive Ignacio CO 81137-0429 |
| Mailing Address |
Po Box 429 Ignacio CO 81137-0429 |
| Practice Telephone | 9705634555 |
| Practice Fax Number | 9705634618 |
| Mailing Telephone | 9705634555 |
| Mailing Fax Number | 9705634618 |
| Enumeration Date | 2009-04-13 |
| Last Update Date | 2009-04-13 |
| Authorized Official Name | MR. DENNIS WILLIAM DAHLKE (PROGRAM DIRECTOR) |
| Authorized Official Telephone | 9705634555 |
| Authorized Official Credential | MED, CACIII, LPC |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 324500000X | Substance Abuse Rehabilitation Facility | 1390 | CO | Residential Treatment Facilities |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| CO | COLORADO STATE DEPARTMENT OF REGLATORY AGENCY | 1390 | 01 |
| Street Address |
296 MOUACHE DRIVE |
| City | IGNACIO |
| State | CO |
| Zip Code | 81137-0429 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1831754332 | Jennifer Antoinette Goodtracks | Counselor | 69 Capote Dr, Ignacio, CO 81137 | 2019-05-09 |
| 1508294281 | Garcia Chiropractic Wellness Center, LLC | Chiropractor | 630 Goddard Avenue, Ignacio, CO 81137 | 2013-10-16 |
| 1033486113 | Karen Wendy Rice | Dietitian, Registered | 123 Wenumuche Ave, Ignacio, CO 81137 | 2011-11-17 |
| 1962706630 | Mary Alyce Cross | Massage Therapist | 14324 Us Highway 172n, Ignacio, CO 81137 | 2011-01-10 |
| 1255644753 | Jessaca Ann Cassady | Counselor | 115 Ute Dr, Ignacio, CO 81137 | 2010-07-26 |
| 1528380599 | Tanya Deen Campbell | Counselor | 285 Lakin St., Ignacio, CO 81137 | 2010-02-18 |
| 1720219215 | Cecilia Ann Tucker | Counselor | 296 Mouache Road, Ignacio, CO 81137 | 2009-07-31 |
| 1750511465 | Carol Lynn Ford | Counselor | 296 Moache Circle, Ignacio, CO 81137 | 2009-07-16 |
| 1164656211 | Peaceful Spirit | Substance Abuse Rehabilitation Facility | 296 Mouache, Ignacio, CO 81137 | 2009-05-05 |
| 1881828937 | Mariellen Walz | Social Worker | 296 Mouache Street, Ignacio, CO 81137 | 2009-05-05 |
| Find all providers in zip 81137 | ||||
| Taxonomy Code | 324500000X |
| Grouping | Residential Treatment Facilities |
| Classification | Substance Abuse Rehabilitation Facility |
| A facility or distinct part of a facility that provides a 24 hr therapeutically planned living and rehabilitative intervention environment for the treatment of individuals with disorders in the abuse of drugs, alcohol, and other substances. |
| Notes: [7/1/2003: modified title, modified definition] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1164656211 | Peaceful Spirit | Substance Abuse Rehabilitation Facility | 296 Mouache, Ignacio, CO 81137 | 2009-05-05 |
| 1033352240 | Sucap | Substance Abuse Rehabilitation Facility | 296 Mouache Rd., Ignacio, CO 81137-0429 | 2009-04-17 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1295336071 | Sobriety House, Inc. | Substance Abuse Rehabilitation Facility | 1368 Elizabeth St, Denver, CO 80206-2309 | 2020-11-06 |
| 1548874308 | Lotus Lodge, LLC | Substance Abuse Rehabilitation Facility | 206 Uvalda St, Aurora, CO 80011-8602 | 2020-08-31 |
| 1710591573 | Lotus Lodge Men, LLC | Substance Abuse Rehabilitation Facility | 16313 E 7th Dr, Aurora, CO 80011-4524 | 2020-08-31 |
| 1710509583 | Crossroads' Turning Points, Inc. | Substance Abuse Rehabilitation Facility | 1004 Carbon Place, Trinidad, CO 81082 | 2020-05-14 |
| 1538796156 | Rocky Mountain Detox, LLC | Substance Abuse Rehabilitation Facility | 1336 Pierce St, Lakewood, CO 80214-1939 | 2020-03-24 |
| 1215574413 | Healing Pines Recovery, LLC. | Substance Abuse Rehabilitation Facility | 5550 County Road 124, Elizabeth, CO 80107 | 2019-12-06 |
| 1790328607 | Gallus Detox Denver LLC | Substance Abuse Rehabilitation Facility | 5920 S Estes St Ste 150, Littleton, CO 80123-8620 | 2019-10-23 |
| 1114584232 | Scw Recovery LLC | Substance Abuse Rehabilitation Facility | 330 Fiedler Ave, Ste 103, Dillon, CO 80435 | 2019-05-23 |
| 1902462617 | Colorado West Regional Mental Health, Inc. | Substance Abuse Rehabilitation Facility | 2800 Riverside Pkwy Bldg 2, Grand Junction, CO 81501-4721 | 2019-05-17 |
| 1487122057 | Valiant Dtx, LLC | Substance Abuse Rehabilitation Facility | 2602 S Ensenada Way, Aurora, CO 80013-7690 | 2018-11-12 |
| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.