Healthcare Provider Details

I. General information

NPI: 1376243659
Provider Name (Legal Business Name): WHITE HART PSYCHIATRIC AND MENTAL HEALTH SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

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

III. Provider practice location address

1633 FILLMORE ST STE 390
DENVER CO
80206-1586
US

IV. Provider business mailing address

1935 N LOGAN ST APT 1204
DENVER CO
80203-4447
US

V. Phone/Fax

Practice location:
  • Phone: 720-288-1079
  • Fax:
Mailing address:
  • Phone: 312-718-9745
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: JAMES HUFF NIFORATOS
Title or Position: PROVIDER OWNER
Credential: APN
Phone: 312-718-9745