NPIMap

Organization Active NPI

State of Grace

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Pueblo, CO
National Provider Identifier
1457950958
Registry record updated Apr 15, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Health Clinic/Center (Including Community Mental Health Center)Taxonomy code 261QM0801X
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, 2020
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
Robert R MaesNPI 1356611677
Title
Clinical Director
Phone
(719) 569-7909

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
Mental Health Clinic/Center (Including Community Mental Health Center) 261QM0801X 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

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.

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": "1603670400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1618444800000",
    "number": "1457950958",
    "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": [],
    "basic": {
        "organization_name": "STATE OF GRACE",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-10-26",
        "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": "R",
        "authorized_official_title_or_position": "CLINICAL DIRECTOR",
        "authorized_official_telephone_number": "719-569-7909"
    },
    "taxonomies": [
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": null,
            "license": null,
            "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.