=====================================================
General NPI Number Information
=====================================================
NPI Number | 1235164633
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | VALLEY HOPE ASSOCIATION
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/12/2006
-----------------------------------------------------
Last Update Date | 11/19/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 7108 S ALTON WAY STE A
-----------------------------------------------------
City | CENTENNIAL
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 80112-2108
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 303-694-3829
-----------------------------------------------------
Fax | 803-694-3846
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 510 103 S WABASH AVE
-----------------------------------------------------
City | NORTON
-----------------------------------------------------
State | KS
-----------------------------------------------------
Zip | 67654-0510
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 785-877-5111
-----------------------------------------------------
Fax | 785-877-2322
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DIRECTOR OF CONTRACT ADMINISTRATION
-----------------------------------------------------
Name | KATHY ERBERT
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 785-877-5111
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QR0405X
-----------------------------------------------------
Taxonomy Name | Substance Use Disorder Rehabilitation Clinic/Center
-----------------------------------------------------
License Number | 1414-01
-----------------------------------------------------
License Number State | CO
-----------------------------------------------------