1194313700 NPI number — MEN AND WOMEN SEEKING EMPOWEMENT

Table of content: (NPI 1194313700)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1194313700 NPI number — MEN AND WOMEN SEEKING EMPOWEMENT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MEN AND WOMEN SEEKING EMPOWEMENT
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:
1194313700
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/08/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
100 E SOUTH BOULDER RD STE 105
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LAFAYETTE
Provider Business Mailing Address State Name:
CO
Provider Business Mailing Address Postal Code:
80026-1968
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
303-665-7037
Provider Business Mailing Address Fax Number:
720-890-7111

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3161 COUNTY ROAD 62E
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WELLINGTON
Provider Business Practice Location Address State Name:
CO
Provider Business Practice Location Address Postal Code:
80549-3272
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
303-665-7037
Provider Business Practice Location Address Fax Number:
720-890-7111
Provider Enumeration Date:
01/08/2021

Additional Information

Authorized Official

Authorized Official Last Name:
HUNTOON
Authorized Official First Name:
SHARON
Authorized Official Middle Name:
Authorized Official Title or Position:
THERAPIST
Authorized Official Telephone Number:
303-665-7037

Provider Taxonomy Codes

  • Taxonomy code: 251S00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 80776230 , issued by the state of ( CO ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com