Basic Information
| Provider Information | |||||||||
| NPI: | 1861637829 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | NORTH COLORADO MEDICAL CENTER BEHAVIORAL HEALTH | ||||||||
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| Mailing Information | |||||||||
| Address1: | 16 OAK ST | ||||||||
| Address2: | |||||||||
| City: | WINDSOR | ||||||||
| State: | CO | ||||||||
| PostalCode: | 805505434 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9704600179 | ||||||||
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| Practice Location | |||||||||
| Address1: | 928 12TH ST | ||||||||
| Address2: | |||||||||
| City: | GREELEY | ||||||||
| State: | CO | ||||||||
| PostalCode: | 806314024 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9703364908 | ||||||||
| FaxNumber: | 9703365000 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/04/2008 | ||||||||
| LastUpdateDate: | 12/04/2008 | ||||||||
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| AuthorizedOfficialLastName: | SHATTUCK | ||||||||
| AuthorizedOfficialFirstName: | POLLY | ||||||||
| AuthorizedOfficialMiddleName: | ANNE | ||||||||
| AuthorizedOfficialTitleorPosition: | INTAKE AND ASSESSMENT THERAPIST | ||||||||
| AuthorizedOfficialTelephone: | 9703364908 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | NORTH COLORADO MEDICAL CENTER | ||||||||
| AuthorizedOfficialNamePrefix: | MISS | ||||||||
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| AuthorizedOfficialCredential: | MSW | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 283Q00000X | Y | Hospitals | Psychiatric Hospital |
No ID Information.