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General NPI Number Information
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NPI Number | 1487122057
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Entity Type | Organization
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Legal Business Name | VALIANT DTX, LLC
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Dates
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Enumeration Date | 11/12/2018
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Last Update Date | 03/10/2025
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Provider Practice Location Address
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Address Line | 6994 COUNTY ROAD 39
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City | FORT LUPTON
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State | CO
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Zip | 80621-8528
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Country | US
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Telephone | 720-802-0497
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Fax | 303-265-9494
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Provider Business Mailing Address
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Address Line | 5600 S QUEBEC ST STE 126B
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City | GREENWOOD VILLAGE
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State | CO
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Zip | 80111-2209
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Country | US
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Telephone | 720-802-0497
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Fax | 303-265-9494
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Authorized Official
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Title or Position | CEO
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Name | MICHAEL DINNEEN
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Credential |
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Telephone | 720-802-0497
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 324500000X
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Taxonomy Name | Substance Abuse Rehabilitation Facility
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License Number |
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License Number State |
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