Healthcare Provider Details

I. General information

NPI: 1851417679
Provider Name (Legal Business Name): MILE HIGH COUNCIL ON ALCOHOLISM AND DRUG ABUSE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/22/2007
Last Update Date: 10/07/2020
Certification Date: 10/07/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4242 DELAWARE ST
DENVER CO
80216
US

IV. Provider business mailing address

PO BOX 919
AURORA CO
80040-0919
US

V. Phone/Fax

Practice location:
  • Phone: 303-825-8113
  • Fax: 303-825-8166
Mailing address:
  • Phone: 303-825-8113
  • Fax: 303-825-8166

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number1283-000
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number1283-000
License Number StateCO
# 3
Primary TaxonomyN
Taxonomy Code251V00000X
TaxonomyVoluntary or Charitable Agency
License Number1283-000
License Number StateCO
# 4
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number1283-000
License Number StateCO

VIII. Authorized Official

Name: MR. ROBERT E. DORSHIMER
Title or Position: EXECUTIVE DIRECTOR
Credential: MA.,ED, CACIII
Phone: 303-825-8113