Provider Demographics
NPI: | 1053475830 |
---|---|
Name: | AURORA COMPREHENSIVE COMMUNITY MENTAL HEALTH CENTER, INC |
Entity type: | Organization |
Organization Name: | AURORA COMPREHENSIVE COMMUNITY MENTAL HEALTH CENTER, INC |
Other - Org Name: | <UNAVAIL> |
Other - Org Type: | |
Authorized Official - Title/Position: | CREDENTIALING |
Authorized Official - Prefix: | |
Authorized Official - First Name: | DEBBIE |
Authorized Official - Middle Name: | |
Authorized Official - Last Name: | GRACE |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | |
Authorized Official - Phone: | 303-617-2300 |
Mailing Address - Street 1: | 1290 CHAMBERS RD |
Mailing Address - Street 2: | |
Mailing Address - City: | AURORA |
Mailing Address - State: | CO |
Mailing Address - Zip Code: | 80011-7117 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 303-617-2300 |
Mailing Address - Fax: | |
Practice Address - Street 1: | 1646 ELMIRA ST |
Practice Address - Street 2: | |
Practice Address - City: | AURORA |
Practice Address - State: | CO |
Practice Address - Zip Code: | 80010-2122 |
Practice Address - Country: | US |
Practice Address - Phone: | 303-617-2300 |
Practice Address - Fax: | |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2006-12-19 |
Last Update Date: | 2020-09-24 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 261QM0801X | Ambulatory Health Care Facilities | Clinic/Center | Mental Health (Including Community Mental Health Center) |