Healthcare Provider Details

I. General information

NPI: 1801900238
Provider Name (Legal Business Name): MOUNT ST. VINCENT HOME
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/19/2006
Last Update Date: 03/14/2025
Certification Date: 03/14/2025
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 TaxonomyN
Taxonomy Code322D00000X
TaxonomyEmotionally Disturbed Childrens' Residential Treatment Facility
License Number45174
License Number StateCO
# 2
Primary TaxonomyY
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: JENESSA WILLIAMS
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 303-458-7220