Healthcare Provider Details

I. General information

NPI: 1992177596
Provider Name (Legal Business Name): MOUNTAIN CREST BEHAVIORAL HEALTH HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/22/2015
Last Update Date: 10/22/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4601 CORBETT DR
FORT COLLINS CO
80528-9579
US

IV. Provider business mailing address

4601 CORBETT DR
FORT COLLINS CO
80528-9579
US

V. Phone/Fax

Practice location:
  • Phone: 970-207-4800
  • Fax: 970-207-4855
Mailing address:
  • Phone: 970-207-4800
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code283Q00000X
TaxonomyPsychiatric Hospital
License Number00993063
License Number StateCO

VIII. Authorized Official

Name: KAREN WENTE
Title or Position: PROFESSIONAL MENTAL HEALTH PROFESSI
Credential: LCSW
Phone: 970-207-4820