Healthcare Provider Details

I. General information

NPI: 1265935167
Provider Name (Legal Business Name): BEHAVIROAL HEALTH GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/16/2018
Last Update Date: 06/16/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5250 LEETSDALE DR
DENVER CO
80246-1438
US

IV. Provider business mailing address

5250 LEETSDALE DR
DENVER CO
80246-1438
US

V. Phone/Fax

Practice location:
  • Phone: 720-629-5293
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License NumberACC.0020893
License Number StateCO

VIII. Authorized Official

Name: ASHLEY EGAN
Title or Position: SUBSTANCE ABUSE COUNSELOR
Credential: B.S., CACIII
Phone: 303-629-5293