1205098340 NPI number — METRO COMMUNITY PROVIDER NETWORK INC

Table of content: KARIN MARIE ROMP MFT (NPI 1114076361)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1205098340 NPI number — METRO COMMUNITY PROVIDER NETWORK INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
METRO COMMUNITY PROVIDER NETWORK 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:
STRIDE CHC - PEORIA
Provider Other Organization Name Type Code:
5
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:
1205098340
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/04/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7495 W 29TH AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WHEAT RIDGE
Provider Business Mailing Address State Name:
CO
Provider Business Mailing Address Postal Code:
80033-8002
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
303-761-1977
Provider Business Mailing Address Fax Number:
303-343-0247

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3292 PEORIA ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
AURORA
Provider Business Practice Location Address State Name:
CO
Provider Business Practice Location Address Postal Code:
80010-1517
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
303-360-6276
Provider Business Practice Location Address Fax Number:
303-789-7222
Provider Enumeration Date:
06/30/2008

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
PEER
Authorized Official First Name:
APRIL
Authorized Official Middle Name:
Authorized Official Title or Position:
CHIEF FINANCIAL OFFICER
Authorized Official Telephone Number:
303-761-1977

Provider Taxonomy Codes

  • Taxonomy code: 261QC1500X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 261QF0400X , registered in the state of CO ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 05638754 , issued by the state of ( CO ) . This identifiers is of the category "MEDICAID".