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General NPI Number Information
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NPI Number | 1922359371
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Entity Type | Organization
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Legal Business Name | CHERRY CREEK SUBOXONE CLINIC,LLC
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Dates
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Enumeration Date | 09/25/2012
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Last Update Date | 09/25/2012
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Provider Practice Location Address
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Address Line | 3191 S VAUGHN WAY
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City | AURORA
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State | CO
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Zip | 80014-3505
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Country | US
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Telephone | 303-495-5047
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Fax |
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Provider Business Mailing Address
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Address Line | 15741 E PROGRESS DR
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City | CENTENNIAL
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State | CO
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Zip | 80015-4257
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Country | US
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Telephone | 303-495-5047
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Fax |
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | SUZANNE BELIBI
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Credential |
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Telephone | 303-495-5047
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM2500X
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Taxonomy Name | Medical Specialty Clinic/Center
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License Number |
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License Number State |
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