Healthcare Provider Details

I. General information

NPI: 1457008427
Provider Name (Legal Business Name): PATHLIGHT NEUROPSYCHIATRIC CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/09/2022
Last Update Date: 06/02/2023
Certification Date: 06/02/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8101 E LOWRY BLVD STE 110B
DENVER CO
80230-7195
US

IV. Provider business mailing address

7351 E LOWRY BLVD STE 200
DENVER CO
80230-6083
US

V. Phone/Fax

Practice location:
  • Phone: 877-825-8584
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084B0040X
TaxonomyBehavioral Neurology & Neuropsychiatry Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code283Q00000X
TaxonomyPsychiatric Hospital
License Number
License Number State

VIII. Authorized Official

Name: MARINA SHEPEL
Title or Position: CONTRACTING AND CREDENTIALING MANAG
Credential:
Phone: 425-214-9321