Healthcare Provider Details

I. General information

NPI: 1568573442
Provider Name (Legal Business Name): PORTERCARE ADVENTIST HEALTH SYSTEM
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 08/06/2024
Certification Date: 08/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6061 S WILLOW DR STE 210
GREENWOOD VILLAGE CO
80111-5140
US

IV. Provider business mailing address

6901 S HAVANA ST
CENTENNIAL CO
80112-3805
US

V. Phone/Fax

Practice location:
  • Phone: 303-643-1229
  • Fax:
Mailing address:
  • Phone: 303-561-5000
  • Fax: 303-561-5050

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code221700000X
TaxonomyArt Therapist
License Number0696
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code225A00000X
TaxonomyMusic Therapist
License Number0696
License Number StateCO
# 3
Primary TaxonomyY
Taxonomy Code251G00000X
TaxonomyCommunity Based Hospice Care Agency
License Number0696
License Number StateCO

VIII. Authorized Official

Name: JEREMY PITTMAN
Title or Position: CFO
Credential:
Phone: 303-643-1229