Healthcare Provider Details

I. General information

NPI: 1528690195
Provider Name (Legal Business Name): CENTURA VENTURES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/11/2020
Last Update Date: 11/12/2024
Certification Date: 11/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4925 N NEVADA AVE
COLORADO SPRINGS CO
80918-8600
US

IV. Provider business mailing address

PO BOX 801172
KANSAS CITY MO
64180-1172
US

V. Phone/Fax

Practice location:
  • Phone: 719-776-4878
  • Fax: 719-776-4926
Mailing address:
  • Phone: 800-953-0104
  • Fax: 303-765-6670

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MS. DEBRA CARPENTER
Title or Position: VP, AMBULATORY SERVICES
Credential: RN
Phone: 303-765-6998