| Independence Health Center At Jefferson Center For Mental Health | |
|
4851 Independence Street Wheat Ridge CO 80033-6715 | |
| (303) 274-7094 | |
| (303) 274-7095 |
| Full Name | Independence Health Center At Jefferson Center For Mental Health |
|---|---|
| Speciality | Clinic/Center |
| Location | 4851 Independence Street, Wheat Ridge, Colorado |
| Authorized Official Name and Position | Ben R. Wiederholt (PRESIDENT AND CEO) |
| Authorized Official Contact | 3037611977 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Independence Health Center At Jefferson Center For Mental Health 2255 S Oneida St Denver CO 80224-2522 Ph: (303) 761-1977 | Independence Health Center At Jefferson Center For Mental Health 4851 Independence Street Wheat Ridge CO 80033-6715 Ph: (303) 274-7094 |
| NPI Number | 1316233174 |
|---|---|
| Provider Enumeration Date | 06/21/2011 |
| Last Update Date | 03/10/2020 |
| Medicare PECOS PAC ID | 0648181214 |
|---|---|
| Medicare Enrollment ID | O20120831000623 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1316233174 | NPI | - | NPPES |
| 58038230 | Medicaid | CO |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (Colorado) | Primary |
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