Provider Demographics
NPI:1124025143
Name:CITY AND COUNTY OF BROOMFIELD
Entity Type:Organization
Organization Name:CITY AND COUNTY OF BROOMFIELD
Other - Org Name:BROOMFIELD HEALTH AND HUMAN SERVICES
Other - Org Type:Other Name
Authorized Official - Title/Position:PUBLIC HEALTH OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:JASON
Authorized Official - Middle Name:
Authorized Official - Last Name:VAHLING
Authorized Official - Suffix:
Authorized Official - Credentials:MPH
Authorized Official - Phone:720-887-2218
Mailing Address - Street 1:100 SPADER WAY
Mailing Address - Street 2:
Mailing Address - City:BROOMFIELD
Mailing Address - State:CO
Mailing Address - Zip Code:80020-1730
Mailing Address - Country:US
Mailing Address - Phone:720-887-2220
Mailing Address - Fax:720-887-2229
Practice Address - Street 1:100 SPADER WAY
Practice Address - Street 2:
Practice Address - City:BROOMFIELD
Practice Address - State:CO
Practice Address - Zip Code:80020-2441
Practice Address - Country:US
Practice Address - Phone:720-887-2220
Practice Address - Fax:720-887-2229
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-05
Last Update Date:2021-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO251K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO83406328Medicaid