MEDICARE: TRIBE RECOVERY SERVICES INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	101YM0800X	Mental Health Counselor
2	101YP2500X	Professional Counselor
3	324500000X	Substance Abuse Rehabilitation Facility
4	261QM1300X	Multi-Specialty Clinic/Center

General Provider Information

NPI Number	:	1255952552
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TRIBE RECOVERY SERVICES INC

Provider Business Mailing Address
First Line	:	1178 MARIPOSA ST
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80204-3507
Country	:	US
Telephone Number	:	720-608-7423
Fax Number	:

Provider Business Practice Location Address
First Line	:	1178 MARIPOSA ST
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80204-3507
Country	:	US
Telephone Number	:	720-608-7423
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	THOMAS HERNANDEZ
Credential	:
Telephone Number	:	720-608-7423

Provider Enumeration Date	:	04/28/2020
Last Update Date	:	03/15/2022

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Directions to “TRIBE RECOVERY SERVICES INC ” Practice Location

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