1386060515 NPI number — CENTER FOR LIFE CHANGE, INC

Table of content: (NPI 1386060515)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1386060515 NPI number — CENTER FOR LIFE CHANGE, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CENTER FOR LIFE CHANGE, 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:
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:
1386060515
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/28/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
950 WADSWORTH BLVD
Provider Second Line Business Mailing Address:
SUITE 201
Provider Business Mailing Address City Name:
LAKEWOOD
Provider Business Mailing Address State Name:
CO
Provider Business Mailing Address Postal Code:
80214-4591
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
720-748-8113
Provider Business Mailing Address Fax Number:
303-954-0083

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
950 WADSWORTH BLVD
Provider Second Line Business Practice Location Address:
SUITE 201
Provider Business Practice Location Address City Name:
LAKEWOOD
Provider Business Practice Location Address State Name:
CO
Provider Business Practice Location Address Postal Code:
80214-4591
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
720-748-8113
Provider Business Practice Location Address Fax Number:
303-954-0083
Provider Enumeration Date:
03/12/2014

Additional Information

Authorized Official

Authorized Official Last Name:
PLATTNER
Authorized Official First Name:
JANE
Authorized Official Middle Name:
ELLEN
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
720-748-8113

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X , with the licence number:  SW9918097 , 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)

  • Identifier: CSW00991807 . This is a "LICENSE" identifier , issued by the state of ( CO ) . This identifiers is of the category "OTHER".




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