1245849736 NPI number — CHILDREN'S WELLNESS CENTER OF COLORADO

Table of content: (NPI 1245849736)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1245849736 NPI number — CHILDREN'S WELLNESS CENTER OF COLORADO

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CHILDREN'S WELLNESS CENTER OF COLORADO
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:
1245849736
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/17/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
12150 E BRIARWOOD AVE UNIT 202
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CENTENNIAL
Provider Business Mailing Address State Name:
CO
Provider Business Mailing Address Postal Code:
80112-6755
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
720-662-7862
Provider Business Mailing Address Fax Number:
720-573-2862

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2220 CURVE PLAZA
Provider Second Line Business Practice Location Address:
SUITE 203
Provider Business Practice Location Address City Name:
STEAMBOAT SPRINGS
Provider Business Practice Location Address State Name:
CO
Provider Business Practice Location Address Postal Code:
80487
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
720-662-7862
Provider Business Practice Location Address Fax Number:
720-573-2862
Provider Enumeration Date:
07/30/2020

Additional Information

Authorized Official

Authorized Official Last Name:
GARCIA
Authorized Official First Name:
CHRISTINE
Authorized Official Middle Name:
WERNER
Authorized Official Title or Position:
COOWNER
Authorized Official Telephone Number:
720-662-7862

Provider Taxonomy Codes

  • Taxonomy code: 101YM0800X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 60125080 , issued by the state of ( CO ) . This identifiers is of the category "MEDICAID".
  • Identifier: 60155080 , issued by the state of ( CO ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com