Healthcare Provider Details

I. General information

NPI: 1780338640
Provider Name (Legal Business Name): MOUNT ST. VINCENT HOME
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/09/2022
Last Update Date: 02/17/2022
Certification Date: 02/17/2022
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:
Mailing address:
  • Phone: 303-458-7220
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code323P00000X
TaxonomyPsychiatric Residential Treatment Facility
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code322D00000X
TaxonomyEmotionally Disturbed Childrens' Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name: JOSEPH H SHEHATA
Title or Position: DIRECTOR OF FINANCE
Credential:
Phone: 303-458-7220