Healthcare Provider Details

I. General information

NPI: 1548388325
Provider Name (Legal Business Name): JEFFERSON HILLS CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/27/2007
Last Update Date: 12/22/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

421 ZANG ST
LAKEWOOD CO
80228-1052
US

IV. Provider business mailing address

421 ZANG ST
LAKEWOOD CO
80228-1052
US

V. Phone/Fax

Practice location:
  • Phone: 303-989-4357
  • Fax: 303-988-2017
Mailing address:
  • Phone: 303-989-4357
  • Fax: 303-988-2017

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code322D00000X
TaxonomyEmotionally Disturbed Childrens' Residential Treatment Facility
License Number88459
License Number StateCO

VIII. Authorized Official

Name: CHRISTINE ELLIS
Title or Position: CONTROLLER
Credential:
Phone: 303-969-3822