Basic Information
| Provider Information | |||||||||
| NPI: | 1780103259 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | CENTENNIAL MENTAL HEALTH CENTER, INC. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 211 W MAIN ST | ||||||||
| Address2: | |||||||||
| City: | STERLING | ||||||||
| State: | CO | ||||||||
| PostalCode: | 807513168 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9705224549 | ||||||||
| FaxNumber: | 9705224549 | ||||||||
| Practice Location | |||||||||
| Address1: | 1291 CIRCLE DR | ||||||||
| Address2: | |||||||||
| City: | BURLINGTON | ||||||||
| State: | CO | ||||||||
| PostalCode: | 808071245 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7193468183 | ||||||||
| FaxNumber: | 7193460292 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/15/2017 | ||||||||
| LastUpdateDate: | 07/15/2021 | ||||||||
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| AuthorizedOfficialLastName: | HICKMAN | ||||||||
| AuthorizedOfficialFirstName: | ELIZABETH | ||||||||
| AuthorizedOfficialMiddleName: | L | ||||||||
| AuthorizedOfficialTitleorPosition: | EXECUTIVE DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 9705224549 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | CENTENNIAL MENTAL HEALTH CENTER, INC. | ||||||||
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| AuthorizedOfficialCredential: | PHD | ||||||||
| NPICertificationDate: | 07/15/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QR0405X | 1145-02 | CO | Y | Ambulatory Health Care Facilities | Clinic/Center | Rehabilitation, Substance Use Disorder |
No ID Information.