Healthcare Provider Details

I. General information

NPI: 1952897480
Provider Name (Legal Business Name): BOULDER COUNTY COLORADO
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/09/2018
Last Update Date: 02/23/2021
Certification Date: 02/23/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3460 BROADWAY ST
BOULDER CO
80304-1824
US

IV. Provider business mailing address

PO BOX 471 OFFICE OF FINANCIAL MANAGEMENT
BOULDER CO
80306-0471
US

V. Phone/Fax

Practice location:
  • Phone: 303-441-1000
  • Fax:
Mailing address:
  • Phone: 303-441-1000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174H00000X
TaxonomyHealth Educator
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: MS. RAMONA FARINEAU
Title or Position: CHIEF FINANCIAL OFFICER
Credential:
Phone: 303-441-3499