MEDICARE: ALDER GROVE HEALTH SERVICES, INC

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	363LF0000X	Family Nurse Practitioner
2	363LP0808X	Psychiatric/Mental Health Nurse Practitioner

General Provider Information

NPI Number	:	1689122145
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ALDER GROVE HEALTH SERVICES, INC

Provider Business Mailing Address
First Line	:	90 MADISON ST STE 302
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80206-5412
Country	:	US
Telephone Number	:	720-331-6899
Fax Number	:	720-889-9496

Provider Business Practice Location Address
First Line	:	90 MADISON ST STE 302
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80206-5412
Country	:	US
Telephone Number	:	720-331-6899
Fax Number	:	720-889-9496

Authorized Official
Title or Position	:	PSYCHIATRIC NURSE PRACTITIONER
Name	:	HOLLY VAUSE
Credential	:	DNP, PMHNP-BC
Telephone Number	:	720-331-6899

Provider Enumeration Date	:	09/13/2016
Last Update Date	:	11/15/2023

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