=====================================================
General NPI Number Information
=====================================================
NPI Number | 1043260243
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | DIVERSUS HEALTH INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/11/2006
-----------------------------------------------------
Last Update Date | 10/29/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 220 RUSKIN DR
-----------------------------------------------------
City | COLORADO SPRINGS
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 80910-2522
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 719-572-6100
-----------------------------------------------------
Fax | 719-572-6080
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 220 RUSKIN DR
-----------------------------------------------------
City | COLORADO SPRINGS
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 80910-2522
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 719-572-6100
-----------------------------------------------------
Fax | 719-447-4792
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | VP FINANCE
-----------------------------------------------------
Name | GENE CONTRERAS
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 719-572-6197
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 283Q00000X
-----------------------------------------------------
Taxonomy Name | Psychiatric Hospital
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 261QM0801X
-----------------------------------------------------
Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------