Provider Demographics
NPI:1114692126
Name:COLORADO FAMILY CLINIC & PROFESSIONAL RECOVERY INC
Entity Type:Organization
Organization Name:COLORADO FAMILY CLINIC & PROFESSIONAL RECOVERY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:HECTOR
Authorized Official - Middle Name:
Authorized Official - Last Name:LOPEZ FRISBIE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:720-899-3798
Mailing Address - Street 1:4990 KIPLING ST STE B5
Mailing Address - Street 2:
Mailing Address - City:WHEAT RIDGE
Mailing Address - State:CO
Mailing Address - Zip Code:80033-6762
Mailing Address - Country:US
Mailing Address - Phone:303-456-4882
Mailing Address - Fax:
Practice Address - Street 1:4990 KIPLING ST STE B5
Practice Address - Street 2:
Practice Address - City:WHEAT RIDGE
Practice Address - State:CO
Practice Address - Zip Code:80033-6762
Practice Address - Country:US
Practice Address - Phone:303-456-4882
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:COLORADO FAMILY CLINIC & PROFESSIONAL RECOVERY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-08-11
Last Update Date:2021-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QA0401XAllopathic & Osteopathic PhysiciansFamily MedicineAddiction MedicineGroup - Single Specialty