Brad'S House Pueblo

Primary specialty

Emotionally Disturbed Childrens' Residential Treatment FacilityTaxonomy code 322D00000X

Legal business name

BRAD'S HOUSE PUEBLO

Practice address

422 Broadway Ave
Pueblo, CO 81004-2128

Phone

(719) 639-3776

NPI assigned

Apr 12, 2023

Organization subpart

No

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

Authorized official

Name

Samantha Thompson

Title

HR/Billing Director

Phone

(719) 639-3776

Specialties & licenses 1

Addresses

Tax ID family

Brad'S House Pueblo2 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.

• Brad'S House Pueblo

  • Mental Health Counselor
  • Pueblo, CO
  • NPI 1760270706
  NPD tax ID

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

{
    "created_epoch": "1681257600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1681257600000",
    "number": "1437845690",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "14960 WOODCARVER RD # 106",
            "city": "COLORADO SPRINGS",
            "state": "CO",
            "postal_code": "809212370",
            "telephone_number": "719-639-3776"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "422 BROADWAY AVE",
            "city": "PUEBLO",
            "state": "CO",
            "postal_code": "810042128",
            "telephone_number": "719-639-3776"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BRAD'S HOUSE PUEBLO",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-04-12",
        "last_updated": "2023-04-12",
        "certification_date": "2023-04-12",
        "status": "A",
        "authorized_official_last_name": "THOMPSON",
        "authorized_official_first_name": "SAMANTHA",
        "authorized_official_title_or_position": "HR/BILLING DIRECTOR",
        "authorized_official_telephone_number": "719-639-3776"
    },
    "taxonomies": [
        {
            "code": "322D00000X",
            "taxonomy_group": "",
            "desc": "Residential Treatment Facility, Emotionally Disturbed Children",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Suneel Boyareddygari, MD
• Pauline Mae Boyd, LCSW
• Erin Boylan, LPC
• Chun CHI Brace, ND
• Braces4Kids, PLLC
• Brad'S House Pueblo
• Jasmine N Braddock, OTR/L
• Carol Bradford
• William Micheal Bradford, LAC
• Bradley W. Smith, D.O., PLLC

• Emotionally Disturbed Childrens' Residential Treatment Facility in Pueblo, CO
• Providers in Pueblo, CO by specialty
• Emotionally Disturbed Childrens' Residential Treatment Facility in Colorado

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 12, 2023; 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.