Basic Information
| Provider Information | |||||||||
| NPI: | 1720430937 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | DENVER SPRINGS, LLC | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | DENVER SPRINGS | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 101 S 5TH ST STE 3850 | ||||||||
| Address2: | |||||||||
| City: | LOUISVILLE | ||||||||
| State: | KY | ||||||||
| PostalCode: | 402023127 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5025871007 | ||||||||
| FaxNumber: | 5025834446 | ||||||||
| Practice Location | |||||||||
| Address1: | 8835 AMERICAN WAY | ||||||||
| Address2: | |||||||||
| City: | ENGLEWOOD | ||||||||
| State: | CO | ||||||||
| PostalCode: | 801127056 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7206434300 | ||||||||
| FaxNumber: | 7206434301 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/12/2016 | ||||||||
| LastUpdateDate: | 09/11/2020 | ||||||||
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| AuthorizedOfficialLastName: | WALL | ||||||||
| AuthorizedOfficialFirstName: | JOHN | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | GENERAL COUNSEL | ||||||||
| AuthorizedOfficialTelephone: | 4124965959 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 09/11/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 283Q00000X | Y | Hospitals | Psychiatric Hospital |
ID Information
| ID | Type | State | Issuer | Description | 1720430937 | 05 | CO | MEDICAID |