State of Grace

NPI #1164775250 in Pueblo, Colorado

Provider Information

NPI Number: 1164775250
Entity Type: Organization
Organization Name: State of Grace
Primary Specialty: Community/Behavioral Health
Enumeration Date: Oct 26, 2012
Last Updated: Apr 15, 2021

Practice Location

Address: 720 N MAIN ST STE 330
City: Pueblo
State: Colorado
ZIP Code: 81003-3047
Phone: (719) 569-7909

Authorized Official

Name: MR. ROBERT RICHARD MAES JR., CAC III
Title: CLINICAL DIRECTOR
Phone: (719) 240-1799

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Community/Behavioral Health	251S00000X	Primary

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