Healthcare Provider Details

I. General information

NPI: 1013363837
Provider Name (Legal Business Name): DIVERSUS HEALTH INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/11/2016
Last Update Date: 01/09/2024
Certification Date: 01/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

328 10TH ST
CALHAN CO
80808-8446
US

IV. Provider business mailing address

220 RUSKIN DR
COLORADO SPRINGS CO
80910-2522
US

V. Phone/Fax

Practice location:
  • Phone: 719-572-6100
  • Fax:
Mailing address:
  • Phone:
  • Fax:

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: GENE CONTRERAS
Title or Position: VP ACCOUNT & FINANCE
Credential:
Phone: 719-572-6197