Healthcare Provider Details

I. General information

NPI: 1972712701
Provider Name (Legal Business Name): PRINCETON HOUSE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/21/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3884 W PRINCETON CIR
DENVER CO
80236-3111
US

IV. Provider business mailing address

1510 17TH ST
DENVER CO
80202-1202
US

V. Phone/Fax

Practice location:
  • Phone: 303-761-1460
  • Fax: 303-761-3619
Mailing address:
  • Phone: 303-595-4464
  • Fax: 303-595-9225

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3104A0625X
TaxonomyAssisted Living Facility (Mental Illness)
License NumberAL-0197
License Number StateCO

VIII. Authorized Official

Name: TERI J. WHELAN
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 303-595-4464