Healthcare Provider Details

I. General information

NPI: 1346750452
Provider Name (Legal Business Name): COMITIS CRISIS CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/03/2017
Last Update Date: 10/07/2020
Certification Date: 10/07/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2178 VICTOR ST
AURORA CO
80045-7440
US

IV. Provider business mailing address

PO BOX 919
AURORA CO
80040-0919
US

V. Phone/Fax

Practice location:
  • Phone: 303-341-9160
  • Fax:
Mailing address:
  • Phone: 720-975-0155
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number1283-0000
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number1283-0000
License Number StateCO
# 3
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number1283-0000
License Number StateCO
# 4
Primary TaxonomyN
Taxonomy Code251V00000X
TaxonomyVoluntary or Charitable Agency
License Number1283-0000
License Number StateCO

VIII. Authorized Official

Name: AMY HENDERSON
Title or Position: CFO
Credential:
Phone: 720-975-0155