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General NPI Number Information
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NPI Number | 1851327399
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Entity Type | Organization
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Legal Business Name | HERITAGE OUTPATIENT TREATMENT SERVICES LLC
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Dates
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Enumeration Date | 06/25/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1602 S PARKER RD SUITE 214
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City | DENVER
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State | CO
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Zip | 80231-2919
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Country | US
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Telephone | 720-748-0523
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Fax | 720-748-5307
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Provider Business Mailing Address
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Address Line | 1602 S PARKER RD SUITE 214
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City | DENVER
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State | CO
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Zip | 80231-2919
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Country | US
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Telephone | 720-748-0523
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Fax | 720-748-5307
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Authorized Official
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Title or Position | OWNER/DIRECTOR
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Name | MR. ALEXANDER THOMAS JR.
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Credential | CAC III
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Telephone | 720-748-0523
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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 | 1469-01
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License Number State | CO
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