MEDICARE: SPANISH CLINIC 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	261QR0405X	Substance Use Disorder Rehabilitation Clinic/Center

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	ACC-6635	OTHER	CO	CAS
2	ACD-228	OTHER	CO	LAC

General Provider Information

NPI Number	:	1609040773
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SPANISH CLINIC LLC

Provider Business Mailing Address
First Line	:	4200 MORRISON RD UNIT 8
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80219-2490
Country	:	US
Telephone Number	:	303-934-3040
Fax Number	:	303-934-4188

Provider Business Practice Location Address
First Line	:	4200 MORRISON RD UNIT 8
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80219-2490
Country	:	US
Telephone Number	:	303-934-3040
Fax Number	:	303-934-4188

Authorized Official
Title or Position	:	DIRECTOR/OWNER
Name	:	ALFONSO CASTILLO
Credential	:	CAS
Telephone Number	:	720-225-7157

Provider Enumeration Date	:	04/18/2008
Last Update Date	:	03/17/2026

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Directions to “SPANISH CLINIC LLC ” Practice Location

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