Healthcare Provider Details

I. General information

NPI: 1093220063
Provider Name (Legal Business Name): BAMIDBAR OUTDOOR BEHAVIORAL HEALTHCARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/12/2017
Last Update Date: 12/12/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

26601 STONEY PASS RD
SEDALIA CO
80135-9001
US

IV. Provider business mailing address

300 S DAHLIA ST STE 205
DENVER CO
80246-8132
US

V. Phone/Fax

Practice location:
  • Phone: 720-930-4390
  • Fax: 303-261-8210
Mailing address:
  • Phone: 720-930-4390
  • Fax: 303-261-8210

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MS. JORDANA HANSELMAN
Title or Position: DIRECTOR
Credential:
Phone: 720-930-4390