Healthcare Provider Details

I. General information

NPI: 1134983927
Provider Name (Legal Business Name): 11TH HOUR TRAUMA RETREAT, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/12/2024
Last Update Date: 02/12/2024
Certification Date: 02/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7430 E CALEY AVE STE 130
CENTENNIAL CO
80111-6716
US

IV. Provider business mailing address

3386 CARABINER ST
CASTLE ROCK CO
80108-7850
US

V. Phone/Fax

Practice location:
  • Phone: 772-475-3334
  • Fax:
Mailing address:
  • Phone: 772-475-3334
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: RACHAEL STARR
Title or Position: CHIEF EXECUTIVE OFFICER
Credential: LCSW
Phone: 772-475-3334