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General NPI Number Information
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NPI Number | 1023842275
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Entity Type | Organization
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Legal Business Name | COLORADO COMMUNITY CARE, LLC
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Dates
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Enumeration Date | 08/29/2024
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Last Update Date | 08/29/2024
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Provider Practice Location Address
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Address Line | 5701 E EVANS AVE UNIT 100
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City | DENVER
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State | CO
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Zip | 80222-5308
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Country | US
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Telephone | 505-260-9917
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Fax |
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Provider Business Mailing Address
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Address Line | 5701 E EVANS AVE UNIT 100
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City | DENVER
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State | CO
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Zip | 80222-5308
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | DR. SIVAN WILSON
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Credential | PSYD
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Telephone | 720-504-3033
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM2800X
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Taxonomy Name | Methadone Clinic
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License Number |
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License Number State |
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