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NPI Code Detail

MEDICARE: THE STOUT STREET FOUNDATION

MEDICARE: THE STOUT STREET FOUNDATION
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
1324500000XSubstance Abuse Rehabilitation Facility1399-10CO

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
11339-10OTHERCOINTEISIVE RESIDENTAL TREATMENT

General Provider Information

NPI Number : 1902109077
Entity Type Code : Organization
Provider Name (Legal Business Name) : THE STOUT STREET FOUNDATION
Provider Business Mailing Address
First Line : 7251 E 49TH AVE
Second Line :
City : COMMERCE CITY
State : CO
Zip : 80022-4714
Country : US
Telephone Number : 303-468-6148
Fax Number : 303-468-6184
Provider Business Practice Location Address
First Line : 7251 E 49TH AVE
Second Line :
City : COMMERCE CITY
State : CO
Zip : 80022-4714
Country : US
Telephone Number : 303-468-6148
Fax Number : 303-468-6184
Authorized Official
Title or Position : SUPERVISOR
Name : KATIE BRYDON
Credential : LCSW
Telephone Number : 720-401-2340
Provider Enumeration Date : 12/13/2010
Last Update Date : 10/16/2025

Similar Medicare Providers

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80022-4714
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1992925077 — STOUT STREET FOUNDATION
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1669774550 — MR. JOSEPH LORENZO WILBERT CAC III
Practice Location Address:
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COMMERCE CITY, CO
80022-4714
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Practice Fax: 303-468-6184
1164724894 — SHAROL WELLS C.A.C. III
Practice Location Address:
7251 E 49TH AVE
COMMERCE CITY, CO
80022-4714
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Practice Fax:
1538461124 — MR. NICHOLAS JOEL PETRUCELLI CAC III
Practice Location Address:
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80022-4714
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Directions to “THE STOUT STREET FOUNDATION ” Practice Location

Language Start Address Practice Location
These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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