Healthcare Provider Details

I. General information

NPI: 1376024968
Provider Name (Legal Business Name): URBAN PEAKS REHAB, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/22/2018
Last Update Date: 08/22/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1490 N LAFAYETTE ST
DENVER CO
80218-2339
US

IV. Provider business mailing address

1490 N LAFAYETTE ST
DENVER CO
80218-2339
US

V. Phone/Fax

Practice location:
  • Phone: 303-955-5131
  • Fax: 303-955-5181
Mailing address:
  • Phone: 303-955-5131
  • Fax: 303-955-5181

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RA0401X
TaxonomyAddiction Medicine (Internal Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. CHAD R JOHNSTON
Title or Position: MEDICAL DIRECTOR
Credential: MD
Phone: 303-955-5131