1144481102 NPI number — PORTERCARE ADVENTIST HEALTH SYSTEM

Table of content: (NPI 1144481102)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1144481102 NPI number — PORTERCARE ADVENTIST HEALTH SYSTEM

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PORTERCARE ADVENTIST HEALTH SYSTEM
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:
WILLOW CREST HEALTH
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:
1144481102
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/09/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
P.O. BOX 911244
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DENVER
Provider Business Mailing Address State Name:
CO
Provider Business Mailing Address Postal Code:
80291-1244
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
303-486-5401
Provider Business Mailing Address Fax Number:
303-486-5502

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
10371 S. PARKGLENN WAY
Provider Second Line Business Practice Location Address:
SUITE 230A
Provider Business Practice Location Address City Name:
PARKER
Provider Business Practice Location Address State Name:
CO
Provider Business Practice Location Address Postal Code:
80138
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
303-269-4333
Provider Business Practice Location Address Fax Number:
303-220-5053
Provider Enumeration Date:
06/23/2008

Additional Information

Authorized Official

Authorized Official Last Name:
HESSELINK
Authorized Official First Name:
DAVID
Authorized Official Middle Name:
P
Authorized Official Title or Position:
VP-FINANCE PE
Authorized Official Telephone Number:
303-804-8136

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , with the licence number:  19871218588 , registered in the state of CO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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