Provider Demographics
NPI:1053131813
Name:EDC OF DENVER, LLC
Entity type:Organization
Organization Name:EDC OF DENVER, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:ERIK
Authorized Official - Middle Name:
Authorized Official - Last Name:AKHUND
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:303-771-0861
Mailing Address - Street 1:4100 E MISSISSIPPI AVE STE 1300
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80246-3057
Mailing Address - Country:US
Mailing Address - Phone:303-771-0861
Mailing Address - Fax:
Practice Address - Street 1:4100 E MISSISSIPPI AVE STE 700
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80246-3054
Practice Address - Country:US
Practice Address - Phone:303-771-0861
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-10-15
Last Update Date:2024-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness