Basic Information
| Provider Information | |||||||||
| NPI: | 1225263593 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | THIRD WAY CENTER, INC. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 61385 | ||||||||
| Address2: | LOWRY SPROUT | ||||||||
| City: | DENVER | ||||||||
| State: | CO | ||||||||
| PostalCode: | 802068385 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3037809191 | ||||||||
| FaxNumber: | 3037809192 | ||||||||
| Practice Location | |||||||||
| Address1: | 9100 E LOWRY BLVD | ||||||||
| Address2: | LOWRY SPROUT | ||||||||
| City: | DENVER | ||||||||
| State: | CO | ||||||||
| PostalCode: | 802306935 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3037809188 | ||||||||
| FaxNumber: | 7208597703 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/15/2009 | ||||||||
| LastUpdateDate: | 05/15/2009 | ||||||||
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| AuthorizedOfficialLastName: | EISNER | ||||||||
| AuthorizedOfficialFirstName: | DAVID | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | EXECUTIVE DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 3037809191 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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| AuthorizedOfficialCredential: | MA | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 322D00000X | 1547437 | CO | Y | Residential Treatment Facilities | Residential Treatment Facility, Emotionally Disturbed Children |
No ID Information.