Provider Demographics
NPI:1114582855
Name:SEXUAL ASSAULT VICTIM ADVOCATE CENTER
Entity Type:Organization
Organization Name:SEXUAL ASSAULT VICTIM ADVOCATE CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:DOROTHY
Authorized Official - Middle Name:
Authorized Official - Last Name:FARREL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:970-775-2962
Mailing Address - Street 1:921 38TH AVENUE CT
Mailing Address - Street 2:
Mailing Address - City:GREELEY
Mailing Address - State:CO
Mailing Address - Zip Code:80634-1501
Mailing Address - Country:US
Mailing Address - Phone:970-506-4059
Mailing Address - Fax:
Practice Address - Street 1:921 38TH AVENUE CT
Practice Address - Street 2:
Practice Address - City:GREELEY
Practice Address - State:CO
Practice Address - Zip Code:80634-1501
Practice Address - Country:US
Practice Address - Phone:970-506-4059
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-05-08
Last Update Date:2019-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty