MEDICARE: ASPIRE 365 COLORADO LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	103TA0400X	Addiction (Substance Use Disorder) Psychologist
2	101YA0400X	Addiction (Substance Use Disorder) Counselor
3	163WA0400X	Addiction (Substance Use Disorder) Registered Nurse
4	207QA0401X	Addiction Medicine (Family Medicine) Physician
5	2084A0401X	Addiction Medicine (Psychiatry & Neurology) Physician
6	2083A0300X	Addiction Medicine (Preventive Medicine) Physician

General Provider Information

NPI Number	:	1730719394
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ASPIRE 365 COLORADO LLC

Provider Business Mailing Address
First Line	:	9350 S 150 E STE 320
Second Line	:
City	:	SANDY
State	:	UT
Zip	:	84070-2707
Country	:	US
Telephone Number	:	385-352-9696
Fax Number	:

Provider Business Practice Location Address
First Line	:	755 HIGHWAY 105 STE D
Second Line	:
City	:	PALMER LAKE
State	:	CO
Zip	:	80133-8902
Country	:	US
Telephone Number	:	719-229-2046
Fax Number	:

Authorized Official
Title or Position	:	MANAGER
Name	:	MR. KEN A JENSON
Credential	:
Telephone Number	:	719-229-2046

Provider Enumeration Date	:	01/23/2020
Last Update Date	:	10/14/2024

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Directions to “ASPIRE 365 COLORADO LLC ” Practice Location

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