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General NPI Number Information
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NPI Number | 1386413292
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Entity Type | Organization
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Legal Business Name | DENVER YOUTH PROGRAM
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Dates
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Enumeration Date | 12/20/2023
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Last Update Date | 12/20/2023
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Provider Practice Location Address
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Address Line | 1625 E 35TH AVE
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City | DENVER
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State | CO
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Zip | 80205-4083
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Country | US
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Telephone | 303-777-7000
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Fax |
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Provider Business Mailing Address
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Address Line | 1625 E 35TH AVE
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City | DENVER
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State | CO
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Zip | 80205-4083
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Country | US
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Telephone | 303-777-7000
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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 | JOHNNIE WILLIAMS
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Credential |
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Telephone | 720-295-9694
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 405300000X
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Taxonomy Name | Prevention Professional
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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 | 172V00000X
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Taxonomy Name | Community Health Worker
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License Number |
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License Number State |
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