Provider Demographics
NPI:1114316965
Name:NORTHSTAR TRANSITIONS
Entity Type:Organization
Organization Name:NORTHSTAR TRANSITIONS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIR. OF MEDICAL BILLING
Authorized Official - Prefix:MS
Authorized Official - First Name:DALE
Authorized Official - Middle Name:IRENE
Authorized Official - Last Name:MAUGANS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:970-232-5524
Mailing Address - Street 1:2595 CANYON BLVD.
Mailing Address - Street 2:SUITE 460 NORTHSTAR TRANSITIONS
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80302
Mailing Address - Country:US
Mailing Address - Phone:720-340-7140
Mailing Address - Fax:888-373-4385
Practice Address - Street 1:75 MANHATTAN DR.
Practice Address - Street 2:SUITES 110 AND 208 NORTHSTAR TRANSITIONS
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80303
Practice Address - Country:US
Practice Address - Phone:720-340-7140
Practice Address - Fax:888-373-4385
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-16
Last Update Date:2017-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1790-00324500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility