Provider Demographics
NPI:1053051839
Name:ROUNDUP FELLOWSHIP INC
Entity Type:Organization
Organization Name:ROUNDUP FELLOWSHIP INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
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 1:1234 N MEADE AVE
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80909-3602
Practice Address - Country:US
Practice Address - Phone:719-475-8048
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ROUNDUP FELLOWSHIP INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-03-30
Last Update Date:2022-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO09146366Medicaid