=====================================================
General NPI Number Information
=====================================================
NPI Number | 1053131813
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | EDC OF DENVER, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/15/2024
-----------------------------------------------------
Last Update Date | 10/16/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4100 E MISSISSIPPI AVE STE 700
-----------------------------------------------------
City | DENVER
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 80246-3054
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 303-771-0861
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4100 E MISSISSIPPI AVE STE 1300
-----------------------------------------------------
City | DENVER
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 80246-3057
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 303-771-0861
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO
-----------------------------------------------------
Name | ERIK AKHUND
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 303-771-0861
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 320800000X
-----------------------------------------------------
Taxonomy Name | Mental Illness Community Based Residential Treatment Facility
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------