MEDICARE: COLORADO COALITION FOR THE HOMELESS

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	261QF0400X	Federally Qualified Health Center (FQHC)

General Provider Information

NPI Number	:	1508522145
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COLORADO COALITION FOR THE HOMELESS

Provider Business Mailing Address
First Line	:	2111 CHAMPA ST
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80205-2529
Country	:	US
Telephone Number	:	303-293-2220
Fax Number	:

Provider Business Practice Location Address
First Line	:	2180 STOUT ST
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80205-2819
Country	:	US
Telephone Number	:	303-293-2220
Fax Number	:

Authorized Official
Title or Position	:	CFO
Name	:	PETE J STOLLER
Credential	:
Telephone Number	:	303-312-9606

Provider Enumeration Date	:	11/09/2021
Last Update Date	:	11/09/2021

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Directions to “COLORADO COALITION FOR THE HOMELESS ” Practice Location

Language	Start Address	Practice Location

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