MEDICARE: COLORADO HEALTH NETWORK, INC

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	1223D0001X	Public Health Dentistry

General Provider Information

NPI Number	:	1740923051
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COLORADO HEALTH NETWORK, INC

Provider Business Mailing Address
First Line	:	6260 E COLFAX AVE
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80220-1515
Country	:	US
Telephone Number	:	303-837-1501
Fax Number	:	303-837-0388

Provider Business Practice Location Address
First Line	:	6260 E COLFAX AVE
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80220-1515
Country	:	US
Telephone Number	:	303-863-0772
Fax Number	:	303-832-7823

Authorized Official
Title or Position	:	CLINICAL SERVICES OFFICER
Name	:	LILI CARRILLO
Credential	:
Telephone Number	:	303-945-2381

Provider Enumeration Date	:	04/14/2022
Last Update Date	:	04/14/2022

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