Healthcare Provider Details

I. General information

NPI: 1114692126
Provider Name (Legal Business Name): COLORADO FAMILY CLINIC & PROFESSIONAL RECOVERY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/11/2021
Last Update Date: 08/11/2021
Certification Date: 08/11/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4990 KIPLING ST STE B5
WHEAT RIDGE CO
80033-6762
US

IV. Provider business mailing address

4990 KIPLING ST STE B5
WHEAT RIDGE CO
80033-6762
US

V. Phone/Fax

Practice location:
  • Phone: 303-456-4882
  • Fax:
Mailing address:
  • Phone: 303-456-4882
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0401X
TaxonomyAddiction Medicine (Family Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: HECTOR LOPEZ FRISBIE
Title or Position: OWNER
Credential:
Phone: 720-899-3798