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General NPI Number Information
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NPI Number | 1912041518
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Entity Type | Organization
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Legal Business Name | BREA DENVER, LLC
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Dates
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Enumeration Date | 02/16/2007
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Last Update Date | 05/12/2016
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Provider Practice Location Address
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Address Line | 3790 W QUINCY AVE
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City | DENVER
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State | CO
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Zip | 80236-3644
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Country | US
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Telephone | 303-738-8500
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Fax | 303-738-8600
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Provider Business Mailing Address
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Address Line | 6737 W WASHINGTON ST SUITE 2300
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City | MILWAUKEE
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State | WI
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Zip | 53214-5647
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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 | EVP, CHIEF ADMIN. OFFICER
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Name | BRYAN RICHARDSON
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Credential |
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Telephone | 615-564-8131
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 311500000X
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Taxonomy Name | Alzheimer Center (Dementia Center)
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License Number | AL0230
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License Number State | CO
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