Provider Demographics
NPI:1487935144
Name:SOUTHERN COLORADO COMPREHENSIVE COURT SERVICES
Entity type:Organization
Organization Name:SOUTHERN COLORADO COMPREHENSIVE COURT SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:BRADLEY
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:RUSOVICK
Authorized Official - Suffix:
Authorized Official - Credentials:MA CACIII
Authorized Official - Phone:719-334-1010
Mailing Address - Street 1:200 W B ST STE 226
Mailing Address - Street 2:
Mailing Address - City:PUEBLO
Mailing Address - State:CO
Mailing Address - Zip Code:81003-3574
Mailing Address - Country:US
Mailing Address - Phone:719-595-1634
Mailing Address - Fax:719-595-1643
Practice Address - Street 1:200 W B ST STE 226
Practice Address - Street 2:
Practice Address - City:PUEBLO
Practice Address - State:CO
Practice Address - Zip Code:81003-3574
Practice Address - Country:US
Practice Address - Phone:719-595-1634
Practice Address - Fax:719-595-1643
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-09-07
Last Update Date:2011-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO139100324500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility