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General NPI Number Information
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NPI Number | 1821319112
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Entity Type | Organization
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Legal Business Name | EDELEN ENTERPRISES, INC. D/B/A RECOVERY 360
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Dates
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Enumeration Date | 06/21/2010
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Last Update Date | 02/03/2020
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Provider Practice Location Address
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Address Line | 7350 E. PROGRESS PLACE SUITE 100
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City | GREENWOOD VILLAGE
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State | CO
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Zip | 80111-2130
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Country | US
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Telephone | 720-854-5959
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Fax |
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Provider Business Mailing Address
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Address Line | 7350 E. PROGRESS PLACE SUITE 100
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City | GREENWOOD VILLAGE
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State | CO
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Zip | 80111-2130
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Country | US
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Telephone | 720-854-5959
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Fax |
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Authorized Official
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Title or Position | PRESIDENT/EXECUTIVE DIRECTOR
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Name | MS. RONNY M. DE CARLO
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Credential | LMFT, LAC, LPC
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Telephone | 720-854-5959
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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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 | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number |
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License Number State |
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