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General NPI Number Information
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NPI Number | 1750279931
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Entity Type | Organization
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Legal Business Name | ACQUA RECOVERY COLORADO
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Dates
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Enumeration Date | 06/25/2025
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Last Update Date | 06/25/2025
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Provider Practice Location Address
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Address Line | 5353 MANHATTAN CIR STE 101
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City | BOULDER
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State | CO
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Zip | 80303-4200
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Country | US
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Telephone | 303-736-2536
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 982437
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City | PARK CITY
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State | UT
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Zip | 84098-2437
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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 | COO
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Name | SCOTT LISTER
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Credential | RN
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Telephone | 970-987-2583
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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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