| Genesis Outpatient | |
|
685 Citadel Dr E Ste 122a Colorado Springs CO 80909-5314 | |
| (719) 632-3510 | |
| (719) 632-3534 |
| Full Name | Genesis Outpatient |
|---|---|
| Speciality | Community/Behavioral Health |
| Location | 685 Citadel Dr E Ste 122a, Colorado Springs, Colorado |
| Authorized Official Name and Position | Barbara M Vonderharr (OWNER/MANAGER) |
| Authorized Official Contact | 7196323510 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Genesis Outpatient 685 Citadel Dr E Ste 312 Colorado Springs CO 80909-5316 Ph: (719) 632-3510 | Genesis Outpatient 685 Citadel Dr E Ste 122a Colorado Springs CO 80909-5314 Ph: (719) 632-3510 |
| NPI Number | 1619370343 |
|---|---|
| Provider Enumeration Date | 10/08/2014 |
| Last Update Date | 10/31/2024 |
| Certification Date | 10/25/2024 |
| Medicare PECOS PAC ID | 4082053707 |
|---|---|
| Medicare Enrollment ID | O20240415001743 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1619370343 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | 1728-01 (Colorado) | Primary |
| Provider Name | Barbara Vonderharr |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1720547169 PECOS PAC ID: 2365584869 Enrollment ID: I20240424001322 |
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