1235763111 NPI number — SWANN CLINIC FOR BEHAVIORAL HEALTH

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1235763111 NPI number — SWANN CLINIC FOR BEHAVIORAL HEALTH

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SWANN CLINIC FOR BEHAVIORAL 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:
1235763111
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/09/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1001 GRAND AVE
Provider Second Line Business Mailing Address:
SUITE 005
Provider Business Mailing Address City Name:
GLENWOOD SPRINGS
Provider Business Mailing Address State Name:
CO
Provider Business Mailing Address Postal Code:
81601-3642
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
970-924-0484
Provider Business Mailing Address Fax Number:
970-549-2874

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1001 GRAND AVE
Provider Second Line Business Practice Location Address:
SUITE 005
Provider Business Practice Location Address City Name:
GLENWOOD SPRINGS
Provider Business Practice Location Address State Name:
CO
Provider Business Practice Location Address Postal Code:
81601-3642
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
404-819-8900
Provider Business Practice Location Address Fax Number:
970-549-2874
Provider Enumeration Date:
02/28/2020

Additional Information

Authorized Official

Authorized Official Last Name:
HARDY SWANN
Authorized Official First Name:
JESSICA NICHOLE
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
404-819-8900

Provider Taxonomy Codes

  • Taxonomy code: 103K00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1609225440 , issued by the state of ( CO ) . This identifiers is of the category "MEDICAID".




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