Healthcare Provider Details

I. General information

NPI: 1477882504
Provider Name (Legal Business Name): A LIFE WORTH LIVING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/21/2009
Last Update Date: 10/31/2025
Certification Date: 10/31/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1225 REDWOOD ST
FORT COLLINS CO
80524-2052
US

IV. Provider business mailing address

1225 REDWOOD ST
FORT COLLINS CO
80524-2052
US

V. Phone/Fax

Practice location:
  • Phone: 954-587-7771
  • Fax: 954-208-5770
Mailing address:
  • Phone: 303-888-9592
  • Fax: 303-888-9592

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number
License Number StateCO

VIII. Authorized Official

Name: GLEN PETCAVAGE
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 970-484-2023