1518255389 NPI number — CHARTER HEALTHCARE OF NORTHERN COLORADO, LLC

Table of content: MR. ROBERT BEINHOCKER LPCC (NPI 1871380865)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1518255389 NPI number — CHARTER HEALTHCARE OF NORTHERN COLORADO, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CHARTER HEALTHCARE OF NORTHERN COLORADO, LLC
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:
1518255389
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/28/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1562 TAURUS CT.
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LOVELAND
Provider Business Mailing Address State Name:
CO
Provider Business Mailing Address Postal Code:
80537-3280
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
970-667-2273
Provider Business Mailing Address Fax Number:
888-891-0585

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1562 TAURUS CT.
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LOVELAND
Provider Business Practice Location Address State Name:
CO
Provider Business Practice Location Address Postal Code:
80537-3280
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
970-667-2273
Provider Business Practice Location Address Fax Number:
888-891-0585
Provider Enumeration Date:
07/14/2011

Additional Information

Authorized Official

Authorized Official Last Name:
BOAL
Authorized Official First Name:
SYLVIE
Authorized Official Middle Name:
Authorized Official Title or Position:
COMPLIANCE
Authorized Official Telephone Number:
909-644-4965

Provider Taxonomy Codes

  • Taxonomy code: 251E00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 45005877 , issued by the state of ( CO ) . This identifiers is of the category "MEDICAID".




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