Basic Information
Provider Information | |||||||||
NPI: | 1114021433 | ||||||||
EntityType: | 2 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: | CATHOLIC HEALTH INITIATIVES COLORADO | ||||||||
LastName: |   | ||||||||
FirstName: |   | ||||||||
MiddleName: |   | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: |   | ||||||||
OtherOrganizationName: | NAMASTE ALZHEIMER CENTER | ||||||||
OtherOrganizationType: | 3 | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 2425 S COLORADO BLVD | ||||||||
Address2: | SUITE 250 | ||||||||
City: | DENVER | ||||||||
State: | CO | ||||||||
PostalCode: | 802225946 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 8669050165 | ||||||||
FaxNumber: | 3037157010 | ||||||||
Practice Location | |||||||||
Address1: | 2 PENROSE BLVD | ||||||||
Address2: |   | ||||||||
City: | COLORADO SPRINGS | ||||||||
State: | CO | ||||||||
PostalCode: | 809064214 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 7197768500 | ||||||||
FaxNumber: | 7195209709 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 09/08/2006 | ||||||||
LastUpdateDate: | 08/22/2020 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: |   | ||||||||
AuthorizedOfficialLastName: | STOKES | ||||||||
AuthorizedOfficialFirstName: | NANCY | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: | CFO, SENIOR SERVICES | ||||||||
AuthorizedOfficialTelephone: | 3037157013 | ||||||||
IsSoleProprietor: |   | ||||||||
IsOrganizationSubpart: | N | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: | MRS. | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 311500000X | 0817 | CO | Y |   | Nursing & Custodial Care Facilities | Alzheimer Center (Dementia Center) |   |
ID Information
ID | Type | State | Issuer | Description | 85608742 | 05 | CO |   | MEDICAID |