Healthcare Provider Details

I. General information

NPI: 1861905317
Provider Name (Legal Business Name): REVEL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/07/2017
Last Update Date: 03/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1728 N DOWNING ST
DENVER CO
80218-1008
US

IV. Provider business mailing address

1728 N DOWNING ST
DENVER CO
80218-1008
US

V. Phone/Fax

Practice location:
  • Phone: 720-207-7166
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-13-12894
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code320900000X
TaxonomyIntellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
License Number
License Number StateCO

VIII. Authorized Official

Name: STEPHANIE HILL
Title or Position: EXECUTIVE DIRECTOR
Credential: BCBA
Phone: 720-207-7166