Provider Demographics
NPI:1306149810
Name:DESERT WATERS CORRECTIONAL OUTREACH
Entity type:Organization
Organization Name:DESERT WATERS CORRECTIONAL OUTREACH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:CATERINA
Authorized Official - Middle Name:
Authorized Official - Last Name:SPINARIS
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:719-784-4727
Mailing Address - Street 1:PO BOX 355
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:CO
Mailing Address - Zip Code:81226-0355
Mailing Address - Country:US
Mailing Address - Phone:719-784-4727
Mailing Address - Fax:
Practice Address - Street 1:431 E MAIN ST
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:CO
Practice Address - Zip Code:81226-1534
Practice Address - Country:US
Practice Address - Phone:719-784-4727
Practice Address - Fax:719-784-2214
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-06
Last Update Date:2010-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health