MEDICARE: STREETS HOPE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)

General Provider Information

NPI Number	:	1013562032
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	STREETS HOPE

Provider Business Mailing Address
First Line	:	PO BOX 19416
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80219-0416
Country	:	US
Telephone Number	:	720-420-9951
Fax Number	:

Provider Business Practice Location Address
First Line	:	1420 N OGDEN ST STE 103
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80218-1981
Country	:	US
Telephone Number	:	720-420-9951
Fax Number	:

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	CAROLINE MCKINNON
Credential	:
Telephone Number	:	720-420-9951

Provider Enumeration Date	:	08/06/2019
Last Update Date	:	08/06/2019

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Directions to “STREETS HOPE ” Practice Location

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