Healthcare Provider Details

I. General information

NPI: 1881055903
Provider Name (Legal Business Name): COMMUNITY COACHING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/17/2016
Last Update Date: 11/16/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12102 E 10TH AVE
AURORA CO
80011-6213
US

IV. Provider business mailing address

401 S JERSEY ST
DENVER CO
80224-1215
US

V. Phone/Fax

Practice location:
  • Phone: 720-308-7190
  • Fax:
Mailing address:
  • Phone: 720-308-7190
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code385HR2060X
TaxonomyChild Intellectual and/or Developmental Disabilities Respite Care
License Number
License Number State

VIII. Authorized Official

Name: TINA WATERS
Title or Position: DIRECTOR
Credential: M.A.
Phone: 720-308-7190