MEDICARE: PORTERCARE ADVENTIST HEALTH SYSTEM

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)	1096-00	CO

General Provider Information

NPI Number	:	1427170083
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PORTERCARE ADVENTIST HEALTH SYSTEM

Provider Business Mailing Address
First Line	:	PO BOX 801106
Second Line	:
City	:	KANSAS CITY
State	:	MO
Zip	:	64180-1106
Country	:	US
Telephone Number	:	800-953-0104
Fax Number	:	303-765-6670

Provider Business Practice Location Address
First Line	:	960 E HARVARD AVE FL 1, MASON HALL
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80210-7008
Country	:	US
Telephone Number	:	303-778-5774
Fax Number	:	303-778-2436

Authorized Official
Title or Position	:	ADMINISTRATOR, OMA
Name	:	MRS. ANGELA J SKINNER
Credential	:
Telephone Number	:	303-673-7175

Provider Enumeration Date	:	04/04/2007
Last Update Date	:	04/08/2022

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