Healthcare Provider Details

I. General information

NPI: 1003024779
Provider Name (Legal Business Name): ROUNDUP FELLOWSHIP INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/18/2007
Last Update Date: 03/30/2022
Certification Date: 03/30/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3443 S GALENA ST STE 310
DENVER CO
80231-5079
US

IV. Provider business mailing address

3443 S GALENA ST STE 310
DENVER CO
80231-5079
US

V. Phone/Fax

Practice location:
  • Phone: 303-757-8008
  • Fax: 303-353-8305
Mailing address:
  • Phone: 303-757-8008
  • Fax: 303-353-8305

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code320900000X
TaxonomyIntellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
License Number45201
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code320900000X
TaxonomyIntellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
License Number45105
License Number StateCO
# 3
Primary TaxonomyN
Taxonomy Code320900000X
TaxonomyIntellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
License Number45211
License Number StateCO
# 4
Primary TaxonomyN
Taxonomy Code320900000X
TaxonomyIntellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
License Number45212
License Number StateCO
# 5
Primary TaxonomyY
Taxonomy Code320900000X
TaxonomyIntellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name: MS. DONNA THURSTON
Title or Position: CHIEF EXECUTIVE OFFICER
Credential:
Phone: 719-666-7823