Provider Demographics
NPI:1033506613
Name:EATING DISORDER CENTER OF DENVER
Entity Type:Organization
Organization Name:EATING DISORDER CENTER OF DENVER
Other - Org Name:EDC OF DENVER, LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE ASSISTANT
Authorized Official - Prefix:
Authorized Official - First Name:DAWN
Authorized Official - Middle Name:
Authorized Official - Last Name:SULLIVAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:720-889-4227
Mailing Address - Street 1:950 S CHERRY ST
Mailing Address - Street 2:SUITE 1010
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80246-2699
Mailing Address - Country:US
Mailing Address - Phone:303-771-0861
Mailing Address - Fax:
Practice Address - Street 1:950 S CHERRY ST
Practice Address - Street 2:SUITE 1010
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80246-2699
Practice Address - Country:US
Practice Address - Phone:303-771-0861
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-21
Last Update Date:2015-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0012373101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty