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General NPI Number Information
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NPI Number | 1114817780
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Entity Type | Organization
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Legal Business Name | AVA HEALTH, LLC
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Dates
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Enumeration Date | 07/07/2025
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Last Update Date | 07/14/2025
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Provider Practice Location Address
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Address Line | 52254 KE RD
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City | MOLINA
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State | CO
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Zip | 81646-5033
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Country | US
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Telephone | 609-703-5006
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Fax |
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Provider Business Mailing Address
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Address Line | 1646 S DEFRAME ST UNIT B8
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City | LAKEWOOD
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State | CO
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Zip | 80228-6015
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Country | US
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Telephone | 609-703-5006
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Fax |
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Authorized Official
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Title or Position | CHIEF OPERATING OFFICER
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Name | IAN GERSHMAN
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Credential | MBA, MA, CADC II
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Telephone | 609-703-5006
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QR0405X
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Taxonomy Name | Substance Use Disorder Rehabilitation Clinic/Center
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License Number |
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License Number State |
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