1437326097 NPI number — COMMUNITY HEALTH INITIATIVES

Table of content: (NPI 1437326097)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1437326097 NPI number — COMMUNITY HEALTH INITIATIVES

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
COMMUNITY HEALTH INITIATIVES
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:
PATHWAYS ADOLESCENT RECOVERY PROGRAM
Provider Other Organization Name Type Code:
5
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:
1437326097
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/13/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
0189 JW DRIVE UNIT B SUITE 2-3
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CARBONDALE
Provider Business Mailing Address State Name:
CO
Provider Business Mailing Address Postal Code:
81623-8776
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
970-963-6013
Provider Business Mailing Address Fax Number:
970-963-6015

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2001 BLAKE AVE SUITE 1A
Provider Second Line Business Practice Location Address:
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
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
970-945-2614
Provider Business Practice Location Address Fax Number:
970-947-9158
Provider Enumeration Date:
05/13/2008

Additional Information

Authorized Official

Authorized Official Last Name:
EVANS
Authorized Official First Name:
MICHELE
Authorized Official Middle Name:
ANN
Authorized Official Title or Position:
EXECUTIVE DIRECTOR
Authorized Official Telephone Number:
970-945-2614

Provider Taxonomy Codes

  • Taxonomy code: 261QR0405X , with the licence number:  6566 , 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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