1912174459 NPI number — COLORADO CENTER FOR BIOBEHAVIORAL HEALTH

Table of content: (NPI 1912174459)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1912174459 NPI number — COLORADO CENTER FOR BIOBEHAVIORAL HEALTH

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
COLORADO CENTER FOR BIOBEHAVIORAL HEALTH
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:
Provider Other Organization Name Type Code:
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:
1912174459
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/17/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1229 KALMIA AVE.
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BOULDER
Provider Business Mailing Address State Name:
CO
Provider Business Mailing Address Postal Code:
80304-1310
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
303-449-8815
Provider Business Mailing Address Fax Number:
720-524-6965

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1229 KALMIA 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:
80304-1810
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
303-449-8815
Provider Business Practice Location Address Fax Number:
720-524-6965
Provider Enumeration Date:
05/14/2008

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
SCHNEIDER
Authorized Official First Name:
CAROL
Authorized Official Middle Name:
J
Authorized Official Title or Position:
DIRECTOR
Authorized Official Telephone Number:
303-449-2364

Provider Taxonomy Codes

  • Taxonomy code: 103TC0700X , with the licence number:  322 , registered in the state of CO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 2084P0800X , with the licence number: 16419 , 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)