Healthcare Provider Details

I. General information

NPI: 1538310578
Provider Name (Legal Business Name): DENVER HEALTH/OBHS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/08/2008
Last Update Date: 10/08/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

777 BANNOCK ST UNIT 9 777 BANNOCK ST. UNIT-9
DENVER CO
80204-4507
US

IV. Provider business mailing address

777 BANNOCK ST UNIT 9 777 BANNOCK ST. UNIT-9
DENVER CO
80204-4507
US

V. Phone/Fax

Practice location:
  • Phone: 303-436-5707
  • Fax: 303-436-5071
Mailing address:
  • Phone: 303-436-5707
  • Fax: 303-436-5071

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code276400000X
TaxonomySubstance Use Disorder Rehabilitation Hospital Unit
License Number3288
License Number StateCO
# 2
Primary TaxonomyY
Taxonomy Code276400000X
TaxonomySubstance Use Disorder Rehabilitation Hospital Unit
License Number5009
License Number StateCO

VIII. Authorized Official

Name: MRS. PAULA KAY WODSTROM
Title or Position: EMPLOYEE ASSITANCE COUNSELOR
Credential: LPC, CACIII
Phone: 303-436-5707