1184774135 NPI number — MENTAL HEALTH CENTER OF BOULDER COUNTY, INC.

Table of content: (NPI 1184774135)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1184774135 NPI number — MENTAL HEALTH CENTER OF BOULDER COUNTY, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MENTAL HEALTH CENTER OF BOULDER COUNTY, INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
MENTAL HEALTH PARTNERS
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1184774135
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/18/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1455 DIXON AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LAFAYETTE
Provider Business Mailing Address State Name:
CO
Provider Business Mailing Address Postal Code:
80026-8879
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
34-438-5003
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1000 ALPINE AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BOULDER
Provider Business Practice Location Address State Name:
CO
Provider Business Practice Location Address Postal Code:
80304-3406
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
303-443-8500
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/11/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
ADAMS
Authorized Official First Name:
SARAH
Authorized Official Middle Name:
Authorized Official Title or Position:
DIRECTOR OF HIM AND COMPLIANCE
Authorized Official Telephone Number:
303-247-8791

Provider Taxonomy Codes

  • Taxonomy code: 261QM0801X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 261QR0405X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 09408533 , issued by the state of ( CO ) . This identifiers is of the category "MEDICAID".