Provider Demographics
NPI:1679317358
Name:AUTHENTIC RECOVERY SERVICES LTD
Entity type:Organization
Organization Name:AUTHENTIC RECOVERY SERVICES LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF OPERATING OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:BREONNA
Authorized Official - Middle Name:LA'RIE
Authorized Official - Last Name:MAHANA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:720-965-2944
Mailing Address - Street 1:1919 MILE HIGH STADIUM CIR APT 1131
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80204-2773
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3181 W 93RD AVE
Practice Address - Street 2:
Practice Address - City:WESTMINSTER
Practice Address - State:CO
Practice Address - Zip Code:80031-2703
Practice Address - Country:US
Practice Address - Phone:720-766-9093
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-06-19
Last Update Date:2024-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health