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General NPI Number Information
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NPI Number | 1154031011
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Entity Type | Organization
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Legal Business Name | MILE HIGH TREATMENT AND RECOVERY INC
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Dates
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Enumeration Date | 12/01/2022
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Last Update Date | 04/28/2023
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Provider Practice Location Address
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Address Line | 6310 E EXPOSITION AVE
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City | DENVER
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State | CO
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Zip | 80224-1260
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Country | US
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Telephone | 720-756-7162
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Fax |
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Provider Business Mailing Address
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Address Line | 6310 E EXPOSITION AVE
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City | DENVER
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State | CO
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Zip | 80224-1260
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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 | EXECUTIVE DIRECTOR
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Name | RAISA KATANOVA
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Credential | PHARM.D.
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Telephone | 720-756-7162
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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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