Healthcare Provider Details

I. General information

NPI: 1770602799
Provider Name (Legal Business Name): MT. ST. VINCENT HOME
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/29/2007
Last Update Date: 02/01/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4159 LOWELL BLVD
DENVER CO
80211-1658
US

IV. Provider business mailing address

4159 LOWELL BLVD
DENVER CO
80211-1658
US

V. Phone/Fax

Practice location:
  • Phone: 303-458-7220
  • Fax: 303-477-7559
Mailing address:
  • Phone: 303-458-7220
  • Fax: 303-477-7559

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code322D00000X
TaxonomyEmotionally Disturbed Childrens' Residential Treatment Facility
License Number991248
License Number StateCO

VIII. Authorized Official

Name: MR. KIRK DAMON WARD
Title or Position: CLINICAL DIRECTOR
Credential: LCSW
Phone: 303-458-7220