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General NPI Number Information
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NPI Number | 1821903253
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Entity Type | Organization
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Legal Business Name | ANTELOPE RECOVERY LLC
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Dates
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Enumeration Date | 08/18/2026
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Last Update Date | 08/18/2026
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Provider Practice Location Address
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Address Line | 1035 PEARL ST STE 313
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City | BOULDER
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State | CO
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Zip | 80302-5130
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Country | US
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Telephone | 303-578-2391
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Fax |
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Provider Business Mailing Address
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Address Line | 1035 PEARL ST STE 313
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City | BOULDER
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State | CO
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Zip | 80302-5130
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Country | US
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Telephone | 303-578-2391
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Fax |
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Authorized Official
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Title or Position | COO AND CO-FOUNDER
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Name | EKATERINA NIKITINA
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Credential |
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Telephone | 303-578-0451
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0855X
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Taxonomy Name | Adolescent and Children Mental Health Clinic/Center
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License Number |
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License Number State |
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