PREMIUM DIRECT CARE PROVIDERS INC. (NPI# 1346615085) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1346615085 |
| Entity Type | Organization |
| Organization Name | PREMIUM DIRECT CARE PROVIDERS INC. |
| Practice Address |
1612 Bonforte Blvd Pueblo CO 81001-1603 |
| Practice Telephone | 7195433600 |
| Enumeration Date | 2015-12-07 |
| Last Update Date | 2015-12-07 |
| Authorized Official Name | JOANN MADRID (PRESIDENT) |
| Authorized Official Telephone | 7195433600 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 261QD1600X |
Clinic/Center Specialization: Developmental Disabilities |
Ambulatory Health Care Facilities |
| Street Address |
1612 BONFORTE BLVD |
| City | PUEBLO |
| State | CO |
| Zip Code | 81001-1603 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1215300744 | Mary Sianez | Case Manager/Care Coordinator | 1612 Bonforte Blvd, Pueblo, CO 81001-1603 | 2015-11-05 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1588222863 | 1111 Bonforte Opco LLC | Respite Care | 855 Hunter Dr., Pueblo, CO 81001 | 2019-06-03 |
| 1992276026 | Andrew Benjamin Basham | Counselor | 1003 Rupple St Pueblo Co 81001, 606, Pueblo, CO 81001 | 2018-12-16 |
| 1316456981 | Amy R Leibli | Nurse Practitioner | 1080 Chinook Lane, Pueblo, CO 81001 | 2017-09-26 |
| 1457781262 | Ron Concialdi | Dentist | 2037 Jerry Murphy Rd., Pueblo, CO 81001 | 2013-11-14 |
| 1609146950 | Natasha Liette Mondragon | Registered Nurse | 1302 E. 5th, Pueblo, CO 81001 | 2012-01-04 |
| 1023303575 | Malinda Lee Davis | Registered Nurse | 1302 E 5th, Pueblo, CO 81001 | 2011-06-13 |
| 1679876429 | Michael Edward Leyba | Substance Abuse Rehabilitation Facility | 4 Montebello Rd., Pueblo, CO 81001 | 2010-12-17 |
| 1609008796 | Laura Ann Mcmahon | Nurse Practitioner | 4020 Jerry Murphy Rd/, Pueblo, CO 81001 | 2009-08-21 |
| 1730380882 | Corrine Stella Tafoya | Counselor | 44 Calhoun Rd, Pueblo, CO 81001 | 2007-05-29 |
| 1518171008 | George Henry Beck | Dentist | 1700 N Salem Ave, Suite A, Pueblo, CO 81001 | 2007-05-10 |
| Find all providers in zip 81001 | ||||
| Taxonomy Code | 261QD1600X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Developmental Disabilities |
| An entity, facility, or distinct part of a facility providing comprehensive, multidiscipline diagnostic, treatment, therapy, training, and counseling services to children with congenital disorders that precipitate developmental delays and in many instances mental deficiencies (e.g., Cerebral Palsy, metabolic disorders, Sturge-Weber Syndrome, etc.). |
| Notes: [7/1/2003: new] |
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| 1578878757 | Life Support Behavioral Institute | Clinic/Center | 7853 E Arapahoe Ct Ste 3550, Centennial, CO 80112-6827 | 2010-08-12 |
| 1437487915 | Kids On The Move, LLC | Clinic/Center | 1296 Main St Unit C, Windsor, CO 80550-7903 | 2009-11-22 |
| 1285881011 | Skb Therapy Services Inc | Clinic/Center | 10694 W 85th Pl, Arvada, CO 80005-4714 | 2008-08-22 |
| 1588705271 | Smith Agency, Inc. | Clinic/Center | 7169 S Liverpool St, Centennial, CO 80016-1746 | 2007-02-08 |
| 1295367423 | Evoke Behavioral Health LLC | Clinic/Center | 4400 E Evans Ave, Denver, CO 80222-5023 | 2020-02-05 |
| 1497398846 | Laradon Hall Society for Exceptional Children and Adults | Clinic/Center | 5100 Lincoln St, Denver, CO 80216-2056 | 2019-10-17 |
| 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.