Healthcare Provider Details

I. General information

NPI: 1306112784
Provider Name (Legal Business Name): RITE OF PASSAGE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/29/2012
Last Update Date: 03/29/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

28101 E QUINCY AVE
WATKINS CO
80137-9502
US

IV. Provider business mailing address

2560 BUSINESS PKWY
MINDEN NV
89423-8985
US

V. Phone/Fax

Practice location:
  • Phone: 303-766-3000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code322D00000X
TaxonomyEmotionally Disturbed Childrens' Residential Treatment Facility
License Number1565507
License Number StateCO

VIII. Authorized Official

Name: CJ JENKINS-BOWER
Title or Position: CHIEF FINANCIAL OFFICER
Credential:
Phone: 775-267-9411