NPIMap

Organization Active NPI

State of Grace

  • Community/Behavioral Health Agency
  • Pueblo, CO
National Provider Identifier
1164775250
Registry record updated Apr 15, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Behavioral Health AgencyTaxonomy code 251S00000X
License
1727-01 Issued in CO
Legal business name
STATE OF GRACE
Practice address
720 N Main St Ste 330
Pueblo, CO 81003-3047
Phone
(719) 569-7909
NPI assigned
Oct 26, 2012
Last updated
Apr 15, 2021By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 15, 2021

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mr. Robert Richard Maes Jr., CAC IIINPI 1356611677
Title
Clinical Director
Phone
(719) 240-1799

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Community/Behavioral Health Agency 251S00000X 1727-01 CO Primary

Addresses

Primary practice location

720 N Main St Ste 330
Pueblo, CO 81003-3047

Mailing address

720 N Main St Ste 330
Pueblo, CO 81003-3047
Phone (719) 569-7909

Other practice location 1

201 W 8th St Ste 403
Pueblo, CO 81003-3033
Phone (719) 582-5575

National Provider Directory

National Provider Directory
Tax ID family
State of Grace2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

  • State of Grace
    • Mental Health Clinic/Center (Including Community Mental Health Center)
    • Pueblo, CO
    • NPI 1457950958
    NPD tax ID

Locations

201 W 8th St
Ste 403
Pueblo, CO 81003
Phone (719) 248-4695

720 N Main St
Ste 240
Pueblo, CO 81003
Phone (719) 203-7949

720 N Main St
Ste 330
Pueblo, CO 81003
Phone (719) 415-5151

Practitioners & affiliated clinicians

Practitioners 15

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 15

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1351209600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1618444800000",
    "number": "1164775250",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "720 N MAIN ST STE 330",
            "city": "PUEBLO",
            "state": "CO",
            "postal_code": "810033047",
            "telephone_number": "719-569-7909"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "720 N MAIN ST STE 330",
            "city": "PUEBLO",
            "state": "CO",
            "postal_code": "810033047",
            "telephone_number": "719-569-7909"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "201 W 8th St Ste 403",
            "address_purpose": "LOCATION",
            "city": "Pueblo",
            "state": "CO",
            "postal_code": "810033033",
            "country_code": "US",
            "telephone_number": "719-582-5575",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "STATE OF GRACE",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-10-26",
        "last_updated": "2021-04-15",
        "certification_date": "2021-04-15",
        "status": "A",
        "authorized_official_last_name": "MAES",
        "authorized_official_first_name": "ROBERT",
        "authorized_official_middle_name": "RICHARD",
        "authorized_official_title_or_position": "CLINICAL DIRECTOR",
        "authorized_official_telephone_number": "719-240-1799",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_name_suffix": "Jr.",
        "authorized_official_credential": "CAC III"
    },
    "taxonomies": [
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": "CO",
            "license": "1727-01",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Pueblo, CO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 15, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.