Healthcare Provider Details

I. General information

NPI: 1922424076
Provider Name (Legal Business Name): RITES OF PASSAGE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/13/2014
Last Update Date: 08/19/2022
Certification Date: 08/19/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4879 GATEWAY RD.
CRAWFORD CO
81415
US

IV. Provider business mailing address

4979 4200 RD.
CRAWFORD CO
81415
US

V. Phone/Fax

Practice location:
  • Phone: 970-921-4563
  • Fax: 970-921-5420
Mailing address:
  • Phone: 970-921-4563
  • Fax: 970-921-5420

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code320800000X
TaxonomyMental Illness Community Based Residential Treatment Facility
License NumberLPC0011272
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License NumberLPC0011272
License Number StateCO
# 3
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number
License Number State

VIII. Authorized Official

Name: MS. ALISHA M ADRIAN
Title or Position: OWNER, HEAD COUNSELOR
Credential: LPC
Phone: 303-859-7385