Healthcare Provider Details

I. General information

NPI: 1386413292
Provider Name (Legal Business Name): DENVER YOUTH PROGRAM
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/20/2023
Last Update Date: 12/20/2023
Certification Date: 12/20/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1625 E 35TH AVE
DENVER CO
80205-4083
US

IV. Provider business mailing address

1625 E 35TH AVE
DENVER CO
80205-4083
US

V. Phone/Fax

Practice location:
  • Phone: 303-777-7000
  • Fax:
Mailing address:
  • Phone: 303-777-7000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code405300000X
TaxonomyPrevention Professional
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number State

VIII. Authorized Official

Name: JOHNNIE WILLIAMS
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 720-295-9694