Healthcare Provider Details

I. General information

NPI: 1457222614
Provider Name (Legal Business Name): THE SALVATION ARMY INTERMOUNTAIN DIVISION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/12/2025
Last Update Date: 09/12/2025
Certification Date: 09/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2136 CHAMPA ST
DENVER CO
80205-2530
US

IV. Provider business mailing address

1370 N PENNSYLVANIA ST
DENVER CO
80203-5018
US

V. Phone/Fax

Practice location:
  • Phone: 720-305-5665
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174200000X
TaxonomyMeals Provider
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code177F00000X
TaxonomyLodging Provider
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number
License Number State

VIII. Authorized Official

Name: CHRISTOPHER DOUGHTY
Title or Position: DIRECTOR OF RESEARCH & DEVELOPMENT
Credential: MSW, MBA
Phone: 562-491-8320