Provider Demographics
NPI:1679543920
Name:CHILDRENS ARK, INC
Entity type:Organization
Organization Name:CHILDRENS ARK, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:J
Authorized Official - Last Name:WEST
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:719-325-5240
Mailing Address - Street 1:PO BOX 1007
Mailing Address - Street 2:
Mailing Address - City:GREEN MOUNTAIN FALLS
Mailing Address - State:CO
Mailing Address - Zip Code:80819-1007
Mailing Address - Country:US
Mailing Address - Phone:719-684-9511
Mailing Address - Fax:
Practice Address - Street 1:10460 W HIGHWAY 24
Practice Address - Street 2:
Practice Address - City:GREEN MOUNTAIN FALLS
Practice Address - State:CO
Practice Address - Zip Code:80819
Practice Address - Country:US
Practice Address - Phone:719-684-9511
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO04261322D00000X
CO96480322D00000X
CO40322322D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes322D00000XResidential Treatment FacilitiesResidential Treatment Facility, Emotionally Disturbed Children
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO05350319Medicaid