Provider Demographics
NPI:1003024779
Name:ROUNDUP FELLOWSHIP INC
Entity Type:Organization
Organization Name:ROUNDUP FELLOWSHIP INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:MS
Authorized Official - First Name:DONNA
Authorized Official - Middle Name:
Authorized Official - Last Name:THURSTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:719-666-7823
Mailing Address - Street 1:3443 S GALENA ST STE 310
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80231-5079
Mailing Address - Country:US
Mailing Address - Phone:303-757-8008
Mailing Address - Fax:303-353-8305
Practice Address - Street 1:3443 S GALENA ST STE 310
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80231-5079
Practice Address - Country:US
Practice Address - Phone:303-757-8008
Practice Address - Fax:303-353-8305
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-18
Last Update Date:2022-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO45201320900000X
CO45105320900000X
CO45211320900000X
CO45212320900000X
320900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO9000142041Medicaid
CO09146374Medicaid
CO09146382Medicaid
CO09146366Medicaid