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NPI Code Detail

MEDICARE: ALIS BEHAVIORAL HEALTH OF COLORADO LLC

MEDICARE: ALIS BEHAVIORAL HEALTH OF COLORADO 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
1261QM0855XAdolescent and Children Mental Health Clinic/Center

General Provider Information

NPI Number : 1487336574
Entity Type Code : Organization
Provider Name (Legal Business Name) : ALIS BEHAVIORAL HEALTH OF COLORADO LLC
Provider Business Mailing Address
First Line : 1325 S COLORADO BLVD STE B705
Second Line :
City : DENVER
State : CO
Zip : 80222-3383
Country : US
Telephone Number : 888-528-3860
Fax Number :
Provider Business Practice Location Address
First Line : 2921 W 120TH AVE UNIT 100
Second Line :
City : WESTMINSTER
State : CO
Zip : 80234-2944
Country : US
Telephone Number : 888-528-3860
Fax Number :
Authorized Official
Title or Position : CEO
Name : ELI GROSS
Credential :
Telephone Number : 888-528-3860
Provider Enumeration Date : 08/07/2023
Last Update Date : 08/07/2023

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