Basic Information
| Provider Information | |||||||||
| NPI: | 1497420194 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | THIRD WAY CENTER, INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 61385 | ||||||||
| Address2: | |||||||||
| City: | DENVER | ||||||||
| State: | CO | ||||||||
| PostalCode: | 802068385 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3037809191 | ||||||||
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| Practice Location | |||||||||
| Address1: | 4821 S BANNOCK ST | ||||||||
| Address2: | |||||||||
| City: | ENGLEWOOD | ||||||||
| State: | CO | ||||||||
| PostalCode: | 801106534 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3037615001 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/13/2021 | ||||||||
| LastUpdateDate: | 08/13/2021 | ||||||||
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| AuthorizedOfficialLastName: | MARTIN | ||||||||
| AuthorizedOfficialFirstName: | ERIN | ||||||||
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| AuthorizedOfficialTitleorPosition: | DATA OPERATIONS COORDINATOR | ||||||||
| AuthorizedOfficialTelephone: | 3037809191 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 07/15/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 322D00000X | Y | Residential Treatment Facilities | Residential Treatment Facility, Emotionally Disturbed Children |
ID Information
| ID | Type | State | Issuer | Description | 35182377 | 05 | CO | MEDICAID |