Healthcare Provider Details

I. General information

NPI: 1144658261
Provider Name (Legal Business Name): INNERBALANCE HEALTH CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/29/2013
Last Update Date: 10/29/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1414 W 28TH ST
LOVELAND CO
80538-3101
US

IV. Provider business mailing address

1414 W 28TH ST
LOVELAND CO
80538-3101
US

V. Phone/Fax

Practice location:
  • Phone: 970-203-1300
  • Fax: 970-203-0222
Mailing address:
  • Phone: 970-203-1300
  • Fax: 970-203-0222

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number
License Number StateCO

VIII. Authorized Official

Name: MS. SHONTAE LEE
Title or Position: BILLING MANAGER
Credential:
Phone: 954-446-3538