Provider Demographics
NPI:1033755392
Name:METRO COMMUNITY PROVIDER NETWORK, INC.
Entity Type:Organization
Organization Name:METRO COMMUNITY PROVIDER NETWORK, INC.
Other - Org Name:STRIDE CHC - UNION SQUARE HEALTH PLAZA DENTAL CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PATIENT ACCOUNTS MANGER
Authorized Official - Prefix:
Authorized Official - First Name:YOLANDA
Authorized Official - Middle Name:
Authorized Official - Last Name:TREVINO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:303-761-2153
Mailing Address - Street 1:2255 S ONEIDA ST
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80224-2522
Mailing Address - Country:US
Mailing Address - Phone:303-360-6276
Mailing Address - Fax:303-343-0247
Practice Address - Street 1:12055 W 2ND PL # 200
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80228-1506
Practice Address - Country:US
Practice Address - Phone:303-360-6276
Practice Address - Fax:303-343-0247
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:METRO COMMUNITY PROVIDER NETWORK, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-11-21
Last Update Date:2020-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)