1316353485 NPI number — COLORADO HEALTH NETWORK, INC

Table of content: (NPI 1316353485)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1316353485 NPI number — COLORADO HEALTH NETWORK, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
COLORADO HEALTH NETWORK, 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:
HOWARD DENTAL CENTER
Provider Other Organization Name Type Code:
3
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:
1316353485
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/15/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6260 E COLFAX AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DENVER
Provider Business Mailing Address State Name:
CO
Provider Business Mailing Address Postal Code:
80220-1515
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
303-837-0166
Provider Business Mailing Address Fax Number:
303-962-5303

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6260 E COLFAX AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DENVER
Provider Business Practice Location Address State Name:
CO
Provider Business Practice Location Address Postal Code:
80220-1515
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
303-863-0772
Provider Business Practice Location Address Fax Number:
303-832-7823
Provider Enumeration Date:
07/09/2014

Additional Information

Authorized Official

Authorized Official Last Name:
CARRILLO
Authorized Official First Name:
LILI
Authorized Official Middle Name:
Authorized Official Title or Position:
CHIEF CLINICAL OFFICER
Authorized Official Telephone Number:
303-962-5317

Provider Taxonomy Codes

  • Taxonomy code: 261Q00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 261QD0000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 93637357 , issued by the state of ( CO ) . This identifiers is of the category "MEDICAID".
  • Identifier: 04016572 . This is a "PROVIDER NUMBER" identifier , issued by the state of ( CO ) . This identifiers is of the category "OTHER".




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