MEDICARE: A LIFE WORTH LIVING

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
2	101YA0400X	Addiction (Substance Use Disorder) Counselor
3	324500000X	Substance Abuse Rehabilitation Facility	1681-00	CO

Other Identifiers

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

General Provider Information

NPI Number	:	1710292719
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	A LIFE WORTH LIVING

Provider Business Mailing Address
First Line	:	1225 REDWOOD ST
Second Line	:
City	:	FORT COLLINS
State	:	CO
Zip	:	80524
Country	:	US
Telephone Number	:	303-888-9592
Fax Number	:	866-867-8553

Provider Business Practice Location Address
First Line	:	1225 REDWOOD ST
Second Line	:
City	:	FORT COLLINS
State	:	CO
Zip	:	80524
Country	:	US
Telephone Number	:	303-888-9592
Fax Number	:	866-867-8553

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	DR. GLEN EDWARD PETCAVAGE
Credential	:	D.C.
Telephone Number	:	303-888-9592

Provider Enumeration Date	:	08/13/2010
Last Update Date	:	12/09/2025

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Directions to “A LIFE WORTH LIVING ” Practice Location

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