Healthcare Provider Details

I. General information

NPI: 1770930547
Provider Name (Legal Business Name): VA EASTERN COLORADO HEALTH CARE SYSTEM
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/20/2016
Last Update Date: 05/20/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1055 CLERMONT ST
DENVER CO
80220-3808
US

IV. Provider business mailing address

1055 CLERMONT ST
DENVER CO
80220-3808
US

V. Phone/Fax

Practice location:
  • Phone: 303-399-8020
  • Fax:
Mailing address:
  • Phone: 303-399-8020
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code286500000X
TaxonomyMilitary Hospital
License NumberCSW.09924351
License Number StateCO

VIII. Authorized Official

Name: JANINE M SCHIAVONI
Title or Position: CLINICAL SOCIAL WORKER
Credential: LCSW
Phone: 303-399-8020