Healthcare Provider Details

I. General information

NPI: 1861797003
Provider Name (Legal Business Name): STEVE RIOS CACIII
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/19/2011
Last Update Date: 01/19/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7853 E ARAPAHOE CT STE 3550
CENTENNIAL CO
80112-6827
US

IV. Provider business mailing address

PO BOX 18021
DENVER CO
80218-0021
US

V. Phone/Fax

Practice location:
  • Phone: 303-886-6634
  • Fax: 303-600-6629
Mailing address:
  • Phone: 720-530-6084
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number6646
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: