Healthcare Provider Details

I. General information

NPI: 1386209021
Provider Name (Legal Business Name): SEXUAL ASSAULT VICTIM ADVOCATE CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/08/2019
Last Update Date: 05/08/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1570 W 1ST ST
LOVELAND CO
80537-6259
US

IV. Provider business mailing address

1570 W 1ST ST
LOVELAND CO
80537-6259
US

V. Phone/Fax

Practice location:
  • Phone: 970-775-2962
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: DOROTHY FARREL
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 970-775-2962