Healthcare Provider Details

I. General information

NPI: 1528923240
Provider Name (Legal Business Name): BOULDER COMMUNITY HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/16/2025
Last Update Date: 12/16/2025
Certification Date: 12/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1755 48TH ST STE 200T
BOULDER CO
80301-2711
US

IV. Provider business mailing address

PO BOX 9049
BOULDER CO
80301-9049
US

V. Phone/Fax

Practice location:
  • Phone: 303-415-4299
  • Fax: 303-441-2202
Mailing address:
  • Phone: 303-415-4101
  • Fax: 303-415-4769

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: WILLIAM A MUNSON JR.
Title or Position: VP/CFO
Credential:
Phone: 303-485-7433