Healthcare Provider Details

I. General information

NPI: 1386183010
Provider Name (Legal Business Name): KHESED WELLNESS A COLORADO NONPROFIT CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/14/2017
Last Update Date: 06/11/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3401 W 29TH AVE
DENVER CO
80211-3611
US

IV. Provider business mailing address

2255 SHERIDAN BLVD UNIT C, SUITE 224
EDGEWATER CO
80214
US

V. Phone/Fax

Practice location:
  • Phone: 720-575-9889
  • Fax:
Mailing address:
  • Phone: 720-575-9889
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: HEATHER NELSON
Title or Position: DIRECTOR
Credential:
Phone: 972-523-4921