Provider Demographics
NPI:1093737868
Name:DENVER HEALTH & HOSPITAL AUTHORITY
Entity Type:Organization
Organization Name:DENVER HEALTH & HOSPITAL AUTHORITY
Other - Org Name:NORTH HIGH SCHOOL SBHC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:ANSAR
Authorized Official - Middle Name:J
Authorized Official - Last Name:HASSAN
Authorized Official - Suffix:
Authorized Official - Credentials:CPA
Authorized Official - Phone:303-602-7083
Mailing Address - Street 1:777 BANNOCK ST
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80204-4507
Mailing Address - Country:US
Mailing Address - Phone:303-436-6000
Mailing Address - Fax:
Practice Address - Street 1:2960 N SPEER BLVD
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80211-3795
Practice Address - Country:US
Practice Address - Phone:720-423-2718
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-24
Last Update Date:2023-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0900261QF0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO05638796Medicaid