NPI 1164775250
State of Grace
Practice location
- Address
- 720 N Main St STE 330, Pueblo, CO 81003-3047
- Phone
- (719) 569-7909
Authorised official
- Name
- Robert Richard Maes
- Title
- Clinical Director
- Phone
- (719) 240-1799
Registered specialties
Community/Behavioral Health Agency
Primary
Registry record
- NPI
- 1164775250
- Entity type
- Organization
- NPI issued
- 26 Oct 2012
- Record last updated
- 15 Apr 2021
Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.