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General NPI Number Information
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NPI Number | 1871047746
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Entity Type | Organization
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Legal Business Name | GRAND RVER PSYCHIATRY
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Dates
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Enumeration Date | 08/09/2016
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Last Update Date | 08/09/2016
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Provider Practice Location Address
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Address Line | 743 HORIZON CT
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City | GRAND JUNCTION
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State | CO
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Zip | 81506-8701
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Country | US
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Telephone | 970-254-8600
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Fax | 970-254-8603
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Provider Business Mailing Address
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Address Line | 743 HORIZON CT
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City | GRAND JUNCTION
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State | CO
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Zip | 81506-8701
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Country | US
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Telephone | 970-254-8600
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Fax | 970-254-8603
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Authorized Official
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Title or Position | OWNER
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Name | MS. KIM MOHR
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Credential | CNS
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Telephone | 970-254-8600
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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 | 99868
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License Number State | CO
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