Healthcare Provider Details

I. General information

NPI: 1588831044
Provider Name (Legal Business Name): SEXUAL ASSAULT VICTIM ADVOCACY CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/14/2008
Last Update Date: 03/21/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4812 S COLLEGE AVE
FORT COLLINS CO
80525-3723
US

IV. Provider business mailing address

4812 S COLLEGE AVE
FORT COLLINS CO
80525-3723
US

V. Phone/Fax

Practice location:
  • Phone: 970-506-4059
  • Fax:
Mailing address:
  • Phone: 970-506-4059
  • Fax: 970-674-7023

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State

VIII. Authorized Official

Name: MS. DOROTHY FARREL
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 970-472-4204