Healthcare Provider Details

I. General information

NPI: 1568194223
Provider Name (Legal Business Name): ALDER GROVE HEALTH SERVICES, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/29/2022
Last Update Date: 06/29/2022
Certification Date: 06/29/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

343 W DRAKE RD STE 200
FORT COLLINS CO
80526-2880
US

IV. Provider business mailing address

90 MADISON ST STE 302
DENVER CO
80206-5412
US

V. Phone/Fax

Practice location:
  • Phone: 720-331-6899
  • Fax: 720-306-5499
Mailing address:
  • Phone: 720-331-6899
  • Fax: 720-306-5499

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: HOLLY VAUSE
Title or Position: PRESIDENT
Credential: PMHNP
Phone: 720-331-6899