Healthcare Provider Details

I. General information

NPI: 1134977762
Provider Name (Legal Business Name): REGENTS OF THE UNIVERSITY OF COLORADO
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/08/2024
Last Update Date: 05/08/2024
Certification Date: 05/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

750 POTOMAC ST STE L11
AURORA CO
80011-6715
US

IV. Provider business mailing address

3738 W PRINCETON CIR
DENVER CO
80236-3110
US

V. Phone/Fax

Practice location:
  • Phone: 303-288-5991
  • Fax: 303-734-5087
Mailing address:
  • Phone: 303-761-6703
  • Fax: 303-762-2181

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code261QM2800X
TaxonomyMethadone Clinic
License Number
License Number State

VIII. Authorized Official

Name: KRISTEN DIXION
Title or Position: ARTS EXECUTIVE DIRECTOR
Credential: MA, LPC
Phone: 303-734-5022