STATE OF GRACE (NPI# 1457950958) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1457950958 |
| Entity Type | Organization |
| Organization Name | STATE OF GRACE |
| Practice Address |
720 N Main St Ste 330 Pueblo CO 81003-3047 |
| Practice Telephone | 7195697909 |
| Mailing Telephone | 7195697909 |
| Enumeration Date | 2020-10-26 |
| Last Update Date | 2020-10-26 |
| Authorized Official Name | ROBERT R MAES (CLINICAL DIRECTOR) |
| Authorized Official Telephone | 7195697909 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 261QM0801X |
Clinic/Center Specialization: Mental Health (Including Community Mental Health Center) |
Ambulatory Health Care Facilities |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1164775250 | State of Grace | Community/Behavioral Health | 720 N Main St Ste 330, Pueblo, CO 81003-3047 | 2012-10-26 |
| Entity Type | Entity Name | Entity Address |
|---|---|---|
| Colorado Business Entities | State of Grace | 720 N Main St Suite #240, Pueblo, CO 81003 |
| New York State Corporations | STATE OF GRACE INDUSTRIES, LLC | 7014 13th Avenue Suite 202, Brooklyn, New York 11228 |
| Colorado Business Entities | State of Grace LLC | 1811 S Quebec Way, #88, Denver, CO 80231 |
| New York State Corporations | STATE OF GRACE LLC | 1967 Wehrle Drive, Suite 1 #086, Buffalo, Ny 14221 |
| Oregon Corporations, Companies and Business Names | STATE OF GRACE MASSAGE THERAPY & ESTHETICS | 2659 Commercial St Se, Suite 230, Salem, OR 97302 |
| Oregon Corporations, Companies and Business Names | STATE OF GRACE MINISTRIES | 34930 Brooten Road, Pacific City, OR 97135 |
| Indiana Business Entities | STATE OF GRACE, INC. | 1351 Sunriver Lane, New Haven, IN 46774 |
| Street Address |
720 N MAIN ST STE 330 |
| City | PUEBLO |
| State | CO |
| Zip Code | 81003-3047 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1164775250 | State of Grace | Community/Behavioral Health | 720 N Main St Ste 330, Pueblo, CO 81003-3047 | 2012-10-26 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1164042016 | Sunil Kumar | Student in an Organized Health Care Education/Training Program | Parkview Adult Medicine Clinic, 311 West 14th Street, Pueblo, CO 81003 | 2020-04-21 |
| 1497382303 | Pueblo Family Dentistry Pllc | Dentist | 701 N Grand Avenue, Suite B, Pueblo, CO 81003 | 2020-03-23 |
| 1023654241 | Elmer A. Villalon, Dmd, LLC | Clinic/Center | 1225 North Main Street, #207, Pueblo, CO 81003 | 2019-11-22 |
| 1518434349 | Mariam Rahim | Internal Medicine | Parkview Adult Medicine Clinic, 311 West 14th Street, Pueblo, CO 81003 | 2018-10-30 |
| 1003308222 | Julia Mcneice | Internal Medicine | Parkview Medial Center, Parkveiw Adult Medicine Clinic, 311 West 14th Street, Pueblo, CO 81003 | 2018-06-04 |
| 1689164857 | Jessica Sels | Internal Medicine | Parkview Medical Center Adult Medicine Clinic, 311 W 14th St, Pueblo, CO 81003 | 2018-05-14 |
| 1700313459 | Allison Vigil | Occupational Therapist | 1600 W. 24th St, Pueblo, CO 81003 | 2017-05-12 |
| 1245682020 | Paul S Bongat | Internal Medicine | 411 W. 14th St., Parkview Adult Medicine Clinic, Pueblo, CO 81003 | 2016-07-06 |
| 1013368596 | Daniel R Long | Internal Medicine | 411 West 14th Street, Pueblo, CO 81003 | 2016-06-27 |
| 1396195665 | Parkview Medical Center | General Acute Care Hospital | 411 W. 14th St, Pueblo, CO 81003 | 2016-06-17 |
| Find all providers in zip 81003 | ||||
| Taxonomy Code | 261QM0801X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Mental Health (Including Community Mental Health Center) |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1235697616 | Health Solutions | Clinic/Center | 41 Montebello Rd Ste 120, Pueblo, CO 81001-1366 | 2019-03-05 |
| 1790262376 | Connecting Point Counseling Services | Clinic/Center | 503 N Main St Ste 324, Pueblo, CO 81003-3139 | 2018-07-26 |
| 1457419830 | Health Solutions | Clinic/Center | 2003 E 4th St, Pueblo, CO 81001-4150 | 2006-12-05 |
| 1689732075 | Health Solutions | Clinic/Center | 512 Henry Ave, Pueblo, CO 81005-1707 | 2006-12-05 |
| 1700483187 | Health Solutions | Clinic/Center | 41 Montebello Rd, Pueblo, CO 81001-1379 | 2020-10-08 |
| 1366049744 | Health Solutions | Clinic/Center | 1304 Chinook Ln, Pueblo, CO 81001-1851 | 2020-10-08 |
| 1053918623 | Health Solutions | Clinic/Center | 1591 Taos Rd, Pueblo, CO 81006-1232 | 2020-10-06 |
| 1225635113 | Health Solutions | Clinic/Center | 1304 Chinook Ln, Pueblo, CO 81001-1851 | 2020-10-05 |
| 1952908840 | Health Solutions | Clinic/Center | 41 Montebello Rd, Pueblo, CO 81001-1379 | 2020-10-05 |
| 1396342283 | Health Solutions | Clinic/Center | 1302 Chinook Ln, Pueblo, CO 81001-1851 | 2020-10-05 |
| Find all providers in PUEBLO | ||||
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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.