MEDICARE: IDEA FORUM 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	251S00000X	Community/Behavioral Health Agency

General Provider Information

NPI Number	:	1841518404
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	IDEA FORUM INC.

Provider Business Mailing Address
First Line	:	2370 W ALAMEDA AVE UNIT 8
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80223-1991
Country	:	US
Telephone Number	:	303-477-8280
Fax Number	:	303-477-1369

Provider Business Practice Location Address
First Line	:	2370 W ALAMEDA AVE
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80223-1991
Country	:	US
Telephone Number	:	303-477-8280
Fax Number	:	303-477-1369

Authorized Official
Title or Position	:	COO
Name	:	MIGUEL AVINA
Credential	:
Telephone Number	:	303-477-8280

Provider Enumeration Date	:	05/06/2010
Last Update Date	:	05/14/2024

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