Provider Demographics
NPI:1093220063
Name:BAMIDBAR OUTDOOR BEHAVIORAL HEALTHCARE LLC
Entity Type:Organization
Organization Name:BAMIDBAR OUTDOOR BEHAVIORAL HEALTHCARE LLC
Other - Org Name:BAMIDBAR WILDERNESS THERAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:JORDANA
Authorized Official - Middle Name:
Authorized Official - Last Name:HANSELMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:720-930-4390
Mailing Address - Street 1:300 S DAHLIA ST STE 205
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80246-8132
Mailing Address - Country:US
Mailing Address - Phone:720-930-4390
Mailing Address - Fax:303-261-8210
Practice Address - Street 1:26601 STONEY PASS RD
Practice Address - Street 2:
Practice Address - City:SEDALIA
Practice Address - State:CO
Practice Address - Zip Code:80135-9001
Practice Address - Country:US
Practice Address - Phone:720-930-4390
Practice Address - Fax:303-261-8210
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:RAMAH IN THE ROCKIES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-12-12
Last Update Date:2017-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health