Basic Information
| Provider Information | |||||||||
| NPI: | 1447908595 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | BOULDER COMMUNITY HEALTH | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4747 ARAPAHOE AVE | ||||||||
| Address2: | |||||||||
| City: | BOULDER | ||||||||
| State: | CO | ||||||||
| PostalCode: | 803031131 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3034154700 | ||||||||
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| Practice Location | |||||||||
| Address1: | 101 ERIE PKWY STE 104 | ||||||||
| Address2: | |||||||||
| City: | ERIE | ||||||||
| State: | CO | ||||||||
| PostalCode: | 805164071 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3034154450 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 03/16/2022 | ||||||||
| LastUpdateDate: | 03/16/2022 | ||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | MUNSON | ||||||||
| AuthorizedOfficialFirstName: | WILLIAM | ||||||||
| AuthorizedOfficialMiddleName: | A | ||||||||
| AuthorizedOfficialTitleorPosition: | VICE PRESIDENT FINANCE/CFO | ||||||||
| AuthorizedOfficialTelephone: | 3034857433 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | BOULDER COMMUNITY HEALTH | ||||||||
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| NPICertificationDate: | 03/16/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QR0400X | Y | Ambulatory Health Care Facilities | Clinic/Center | Rehabilitation |
No ID Information.