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9200 E Mineral Ave Ste 250 Centennial CO 80112-3412 | |
| (303) 798-2196 | |
| (303) 730-2418 |
| Full Name | |
|---|---|
| Speciality | Substance Abuse Rehabilitation Facility |
| Location | 9200 E Mineral Ave Ste 250, Centennial, Colorado |
| Authorized Official Name and Position | Robert J. Johnson (EXECUTIVE DIRECTOR) |
| Authorized Official Contact | 3037982196 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
9200 E Mineral Ave Ste 250 Centennial CO 80112-3412 Ph: (303) 798-2196 | 9200 E Mineral Ave Ste 250 Centennial CO 80112-3412 Ph: (303) 798-2196 |
| NPI Number | 1699481952 |
|---|---|
| Provider Enumeration Date | 01/30/2023 |
| Last Update Date | 12/16/2024 |
| Certification Date | 12/16/2024 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1699481952 | NPI | - | NPPES |
| 9000178573 | Medicaid | CO |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YA0400X | Counselor - Addiction (substance Use Disorder) | (* (Not Available)) | Secondary |
| 324500000X | Substance Abuse Rehabilitation Facility | (* (Not Available)) | Primary |
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