Healthcare Provider Details

I. General information

NPI: 1740654508
Provider Name (Legal Business Name): BOULDER VALLEY WOMEN'S HEALTH CENTER, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/17/2015
Last Update Date: 11/17/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

82 21ST AVE
LONGMONT CO
80501-2967
US

IV. Provider business mailing address

2855 VALMONT RD
BOULDER CO
80301-1309
US

V. Phone/Fax

Practice location:
  • Phone: 303-774-8671
  • Fax:
Mailing address:
  • Phone: 303-440-9320
  • Fax: 303-440-8769

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0005X
TaxonomyAmbulatory Family Planning Facility
License Number
License Number State

VIII. Authorized Official

Name: SUSAN LEVY
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 303-440-9320