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NPI Code Detail

MEDICARE: URBAN PEAKS REHAB, LLC

MEDICARE: URBAN PEAKS REHAB, LLC
Medicare Provider Information

Scope of Practice

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

# Taxonomy Code Taxonomy License Number License Number State
1207RA0401XAddiction Medicine (Internal Medicine) Physician

General Provider Information

NPI Number : 1376024968
Entity Type Code : Organization
Provider Name (Legal Business Name) : URBAN PEAKS REHAB, LLC
Provider Business Mailing Address
First Line : 1490 N LAFAYETTE ST
Second Line :
City : DENVER
State : CO
Zip : 80218-2339
Country : US
Telephone Number : 303-955-5131
Fax Number : 303-955-5181
Provider Business Practice Location Address
First Line : 1490 N LAFAYETTE ST
Second Line :
City : DENVER
State : CO
Zip : 80218-2339
Country : US
Telephone Number : 303-955-5131
Fax Number : 303-955-5181
Authorized Official
Title or Position : MEDICAL DIRECTOR
Name : DR. CHAD R JOHNSTON
Credential : MD
Telephone Number : 303-955-5131
Provider Enumeration Date : 08/22/2018
Last Update Date : 08/22/2018

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