Healthcare Provider Details

I. General information

NPI: 1124165923
Provider Name (Legal Business Name): EDC OF DENVER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/31/2007
Last Update Date: 08/29/2024
Certification Date: 08/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4100 E MISSISSIPPI AVE STE 1300
DENVER CO
80246
US

IV. Provider business mailing address

4100 E MISSISSIPPI AVE STE 1300
DENVER CO
80246-3057
US

V. Phone/Fax

Practice location:
  • Phone: 303-771-0861
  • Fax:
Mailing address:
  • Phone: 303-771-0861
  • Fax: 720-889-4258

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code283Q00000X
TaxonomyPsychiatric Hospital
License Number1079
License Number StateCO

VIII. Authorized Official

Name: MR. ERIK AKHUND
Title or Position: CEO
Credential:
Phone: 303-771-0861