MEDICARE: COLORADO ADDICTION RECOVERY SERVICES

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

General Provider Information

NPI Number	:	1689495863
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COLORADO ADDICTION RECOVERY SERVICES

Provider Business Mailing Address
First Line	:	4916 S BUCHANAN ST
Second Line	:
City	:	AURORA
State	:	CO
Zip	:	80016-5949
Country	:	US
Telephone Number	:	973-277-5359
Fax Number	:

Provider Business Practice Location Address
First Line	:	18632 E COLUMBIA PL
Second Line	:
City	:	AURORA
State	:	CO
Zip	:	80013-2366
Country	:	US
Telephone Number	:	973-277-5359
Fax Number	:

Authorized Official
Title or Position	:	DIRECTOR OF OPERATIONS
Name	:	BRYAN DISIMONE
Credential	:
Telephone Number	:	973-277-5359

Provider Enumeration Date	:	10/21/2024
Last Update Date	:	10/21/2024

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