Healthcare Provider Details

I. General information

NPI: 1235216532
Provider Name (Legal Business Name): REGENTS OF THE UNIVERSITY OF COLORADO
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/01/2006
Last Update Date: 05/15/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3738 W PRINCETON CIR
DENVER CO
80236-3110
US

IV. Provider business mailing address

3738 W PRINCETON CIR
DENVER CO
80236-3110
US

V. Phone/Fax

Practice location:
  • Phone: 303-761-6703
  • Fax: 303-762-2181
Mailing address:
  • Phone: 303-761-6703
  • Fax: 303-762-2181

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number1094
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code261QM2800X
TaxonomyMethadone Clinic
License Number1094
License Number StateCO
# 3
Primary TaxonomyN
Taxonomy Code3245S0500X
TaxonomyChildren's Substance Abuse Rehabilitation Facility
License Number1094
License Number StateCO
# 4
Primary TaxonomyY
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number1094
License Number StateCO

VIII. Authorized Official

Name: KRISTEN DIXION
Title or Position: ARTS EXECUTIVE DIRECTOR
Credential: LPC
Phone: 303-761-6703