Basic Information
| Provider Information | |||||||||
| NPI: | 1851975486 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | THIRD WAY CENTER, INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 61385 | ||||||||
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| City: | DENVER | ||||||||
| State: | CO | ||||||||
| PostalCode: | 802068385 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3037809191 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1735 PONTIAC ST | ||||||||
| Address2: | |||||||||
| City: | DENVER | ||||||||
| State: | CO | ||||||||
| PostalCode: | 802201831 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3033883545 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/10/2021 | ||||||||
| LastUpdateDate: | 05/10/2021 | ||||||||
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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: | 05/10/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QR0405X | Y | Ambulatory Health Care Facilities | Clinic/Center | Rehabilitation, Substance Use Disorder |
No ID Information.