Provider Demographics
NPI:1003041914
Name:YOUR HEALING PLACE
Entity Type:Organization
Organization Name:YOUR HEALING PLACE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:CARNEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:303-636-0000
Mailing Address - Street 1:7120 E HAMPDEN AVE
Mailing Address - Street 2:SUITE B
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80224-3048
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:7120 E HAMPDEN AVE
Practice Address - Street 2:SUITE B
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80224-3048
Practice Address - Country:US
Practice Address - Phone:303-636-0000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-20
Last Update Date:2009-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO891261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service