Healthcare Provider Details

I. General information

NPI: 1821903253
Provider Name (Legal Business Name): ANTELOPE RECOVERY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/18/2026
Last Update Date: 08/18/2026
Certification Date: 08/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1035 PEARL ST STE 313
BOULDER CO
80302-5130
US

IV. Provider business mailing address

1035 PEARL ST STE 313
BOULDER CO
80302-5130
US

V. Phone/Fax

Practice location:
  • Phone: 303-578-2391
  • Fax:
Mailing address:
  • Phone: 303-578-2391
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: EKATERINA NIKITINA
Title or Position: COO AND CO-FOUNDER
Credential:
Phone: 303-578-0451