Healthcare Provider Details

I. General information

NPI: 1346489572
Provider Name (Legal Business Name): DENVER HEALTH HOSPITAL AUTHORITY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/11/2009
Last Update Date: 02/11/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

667 BANNOCK ST. #9
DENVER CO
80204
US

IV. Provider business mailing address

667 BANNOCK #9
DENVER CO
80204
US

V. Phone/Fax

Practice location:
  • Phone: 303-436-6000
  • Fax:
Mailing address:
  • Phone: 303-436-6000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code276400000X
TaxonomySubstance Use Disorder Rehabilitation Hospital Unit
License NumberCAC2302
License Number StateCO

VIII. Authorized Official

Name: MR. MICHAEL A WILLIAMS
Title or Position: ADDICTIONS COUNSLOR III
Credential: CACIII
Phone: 303-436-6397