Friendly Harbor

Primary specialty

Community/Behavioral Health AgencyTaxonomy code 251S00000X

Legal business name

FRIENDLY HARBOR

Doing business as

Friendly Harbor Community Center

Practice address

2713 N Grand Ave
Pueblo, CO 81003-2453

Phone

(719) 545-2564

NPI assigned

Mar 21, 2020

Organization subpart

No

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

Authorized official

Name

Dr. Elissa Ball, MD

Title

Volunteer Executive Director

Phone

(719) 214-6081

Specialties & licenses 1

Addresses

Other names 1

• Friendly Harbor Community Center Doing business as

Locations

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

{
    "created_epoch": "1584748800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1585785600000",
    "number": "1578199576",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2713 N GRAND AVE",
            "city": "PUEBLO",
            "state": "CO",
            "postal_code": "810032453",
            "telephone_number": "719-545-2564"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2713 N GRAND AVE",
            "city": "PUEBLO",
            "state": "CO",
            "postal_code": "810032453",
            "telephone_number": "719-545-2564"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FRIENDLY HARBOR",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-03-21",
        "last_updated": "2020-04-02",
        "certification_date": "2020-04-02",
        "status": "A",
        "authorized_official_last_name": "BALL",
        "authorized_official_first_name": "ELISSA",
        "authorized_official_title_or_position": "VOLUNTEER EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "719-214-6081",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Friendly Harbor Community Center",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Friendly Harbor Community Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Front Range Urgent Care, Inc

• Community/Behavioral Health Agency in Pueblo, CO
• Providers in Pueblo, CO by specialty
• Community/Behavioral Health Agency in Colorado

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 2, 2020; 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.