Healthcare Provider Details

I. General information

NPI: 1215932884
Provider Name (Legal Business Name): FOREST HEIGHTS LODGE INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/20/2005
Last Update Date: 03/04/2024
Certification Date: 06/26/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13922 DENVER WEST PARKWAY SUITE 150
LAKEWOOD CO
80401
US

IV. Provider business mailing address

13922 DENVER WEST PARKWAY SUITE 150
LAKEWOOD CO
80401
US

V. Phone/Fax

Practice location:
  • Phone: 303-674-6681
  • Fax: 303-674-6805
Mailing address:
  • Phone: 303-674-6681
  • Fax: 303-674-6805

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MARK RYAN HENNINGER
Title or Position: CHIEF EXECUTIVE OFFICER
Credential:
Phone: 303-600-3702