1750996526 NPI number — COMMUNITY REACH CENTER, INC

Table of content: (NPI 1750996526)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1750996526 NPI number — COMMUNITY REACH CENTER, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
COMMUNITY REACH CENTER, 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:
1750996526
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/09/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1870 W 122ND AVE STE 100
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WESTMINSTER
Provider Business Mailing Address State Name:
CO
Provider Business Mailing Address Postal Code:
80234-2075
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
303-853-3500
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4371 E 72ND AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
COMMERCE CITY
Provider Business Practice Location Address State Name:
CO
Provider Business Practice Location Address Postal Code:
80022-1471
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
303-853-3500
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/09/2020

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
SCHRADER
Authorized Official First Name:
RYSHELL
Authorized Official Middle Name:
Authorized Official Title or Position:
BILLING AND CODING MANAGER
Authorized Official Telephone Number:
303-412-6091

Provider Taxonomy Codes

  • Taxonomy code: 261QM0801X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 261QR0405X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 9000154382 , issued by the state of ( CO ) . This identifiers is of the category "MEDICAID".