Healthcare Provider Details

I. General information

NPI: 1912554668
Provider Name (Legal Business Name): DENVER RECOVERY GROUP LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/19/2019
Last Update Date: 04/21/2020
Certification Date: 04/21/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5330 MANHATTAN CIR STE H
BOULDER CO
80303-4240
US

IV. Provider business mailing address

5330 MANHATTAN CIR STE H
BOULDER CO
80303-4240
US

V. Phone/Fax

Practice location:
  • Phone: 720-536-5571
  • Fax:
Mailing address:
  • Phone: 720-536-5571
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0401X
TaxonomyAddiction Medicine (Family Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: KARLA CHAVEZ
Title or Position: BILLING MANAGER
Credential:
Phone: 575-993-5225