Healthcare Provider Details

I. General information

NPI: 1831889922
Provider Name (Legal Business Name): MILESTONE COMMUNITY WELLNESS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/11/2023
Last Update Date: 10/10/2023
Certification Date: 10/10/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

118 MAIN ST STE 200
STERLING CO
80751-4358
US

IV. Provider business mailing address

118 MAIN ST STE 200
STERLING CO
80751-4358
US

V. Phone/Fax

Practice location:
  • Phone: 720-927-7383
  • Fax:
Mailing address:
  • Phone: 720-927-7383
  • Fax:

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 Code261QR0800X
TaxonomyRecovery Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: REBECCA STIEB
Title or Position: ADMINISTRATIVE DIRECTOR
Credential: MA, LPCC
Phone: 720-927-7383