Healthcare Provider Details

I. General information

NPI: 1356471718
Provider Name (Legal Business Name): TENNYSON CENTER FOR CHILDREN
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/06/2007
Last Update Date: 01/15/2024
Certification Date: 12/21/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2950 TENNYSON ST
DENVER CO
80212
US

IV. Provider business mailing address

2950 TENNYSON ST
DENVER CO
80212
US

V. Phone/Fax

Practice location:
  • Phone: 303-433-2541
  • Fax: 303-433-9701
Mailing address:
  • Phone: 303-433-2541
  • Fax: 303-433-9701

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code322D00000X
TaxonomyEmotionally Disturbed Childrens' Residential Treatment Facility
License Number1529814
License Number StateCO

VIII. Authorized Official

Name: MS. MINDY WATROUS
Title or Position: CEO
Credential:
Phone: 619-890-8697