MEDICARE: VALIANT DTX, 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
1	324500000X	Substance Abuse Rehabilitation Facility

General Provider Information

NPI Number	:	1487122057
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VALIANT DTX, LLC

Provider Business Mailing Address
First Line	:	5600 S QUEBEC ST STE 126B
Second Line	:
City	:	GREENWOOD VILLAGE
State	:	CO
Zip	:	80111-2209
Country	:	US
Telephone Number	:	720-802-0497
Fax Number	:	303-265-9494

Provider Business Practice Location Address
First Line	:	6994 COUNTY ROAD 39
Second Line	:
City	:	FORT LUPTON
State	:	CO
Zip	:	80621-8528
Country	:	US
Telephone Number	:	720-802-0497
Fax Number	:	303-265-9494

Authorized Official
Title or Position	:	CEO
Name	:	MICHAEL DINNEEN
Credential	:
Telephone Number	:	720-802-0497

Provider Enumeration Date	:	11/12/2018
Last Update Date	:	03/10/2025

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