Provider Demographics
NPI:1053859348
Name:OFFENDER SERVICES INC
Entity Type:Organization
Organization Name:OFFENDER SERVICES INC
Other - Org Name:CAPROCK BEHAVIORAL SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXEC DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JACK
Authorized Official - Middle Name:L
Authorized Official - Last Name:ANDERSEN
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:970-243-8220
Mailing Address - Street 1:389 ROBERTS COURT
Mailing Address - Street 2:
Mailing Address - City:GRAND JUNCTION
Mailing Address - State:CO
Mailing Address - Zip Code:81504-6155
Mailing Address - Country:US
Mailing Address - Phone:970-243-8220
Mailing Address - Fax:970-243-1511
Practice Address - Street 1:389 ROBERTS COURT
Practice Address - Street 2:
Practice Address - City:GRAND JUNCTION
Practice Address - State:CO
Practice Address - Zip Code:81504-6155
Practice Address - Country:US
Practice Address - Phone:970-243-8220
Practice Address - Fax:970-243-1511
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-07
Last Update Date:2022-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO96822732OtherMEDICAID PROVIDER NUMBER