Healthcare Provider Details

I. General information

NPI: 1679686992
Provider Name (Legal Business Name): BOULDER COMMUNITY HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/17/2006
Last Update Date: 05/29/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1100 BALSAM AVE
BOULDER CO
80304-3404
US

IV. Provider business mailing address

1100 BALSAM AVE
BOULDER CO
80304-3404
US

V. Phone/Fax

Practice location:
  • Phone: 303-440-2273
  • Fax: 303-440-2435
Mailing address:
  • Phone: 303-440-2273
  • Fax: 303-440-2435

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code273Y00000X
TaxonomyRehabilitation Hospital Unit
License Number0909
License Number StateCO

VIII. Authorized Official

Name: MS. CAROL J WOODARD
Title or Position: CONTRACTING AND PROVIDER RELATIONS
Credential:
Phone: 303-938-3295