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NPI Code Detail

MEDICARE: JEFFERSON CENTER FOR MENTAL HEALTH

MEDICARE: JEFFERSON CENTER FOR MENTAL HEALTH
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
1261QM0801XMental Health Clinic/Center (Including Community Mental Health Center)

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1508454596
Entity Type Code : Organization
Provider Name (Legal Business Name) : JEFFERSON CENTER FOR MENTAL HEALTH
Provider Business Mailing Address
First Line : 4851 INDEPENDENCE ST
Second Line :
City : WHEAT RIDGE
State : CO
Zip : 80033-6715
Country : US
Telephone Number : 303-425-0300
Fax Number : 303-432-5071
Provider Business Practice Location Address
First Line : 10295 W KEENE AVE
Second Line :
City : LAKEWOOD
State : CO
Zip : 80235-1104
Country : US
Telephone Number : 303-980-4082
Fax Number : 303-980-4084
Authorized Official
Title or Position : CHIEF FINANCIAL OFFICER
Name : MR. DAVID A GOFF
Credential :
Telephone Number : 303-432-5164
Provider Enumeration Date : 01/05/2021
Last Update Date : 01/05/2021

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Directions to “JEFFERSON CENTER FOR MENTAL HEALTH ” Practice Location

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