1023613585 NPI number — CENTENNIAL MENTAL HEALTH CENTER, INC.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1023613585 NPI number — CENTENNIAL MENTAL HEALTH CENTER, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CENTENNIAL MENTAL HEALTH CENTER, INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1023613585
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/15/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
211 W MAIN ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
STERLING
Provider Business Mailing Address State Name:
CO
Provider Business Mailing Address Postal Code:
80751-3168
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
970-522-4549
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1116 LAKE ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FORT MORGAN
Provider Business Practice Location Address State Name:
CO
Provider Business Practice Location Address Postal Code:
80701-3033
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
970-466-0639
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/02/2020

Additional Information

Authorized Official

Authorized Official Last Name:
DAVIDSON
Authorized Official First Name:
SHERRI
Authorized Official Middle Name:
Authorized Official Title or Position:
FINANCE DIRECTOR
Authorized Official Telephone Number:
970-522-4549

Provider Taxonomy Codes

  • Taxonomy code: 261QR0405X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 04110094 , issued by the state of ( CO ) . This identifiers is of the category "MEDICAID".




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