Provider Demographics
NPI:1144389172
Name:COLORADO CENTER FOR NEUROLOGICAL REHABILITATION INC
Entity Type:Organization
Organization Name:COLORADO CENTER FOR NEUROLOGICAL REHABILITATION INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT CEO CLINICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:ALLEN
Authorized Official - Last Name:COOK
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:303-741-1077
Mailing Address - Street 1:7400 E ARAPAHOE ROAD
Mailing Address - Street 2:SUITE 212
Mailing Address - City:ENGLEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80112
Mailing Address - Country:US
Mailing Address - Phone:303-741-1077
Mailing Address - Fax:303-741-1078
Practice Address - Street 1:7400 E ARAPAHOE ROAD
Practice Address - Street 2:SUITE 212
Practice Address - City:ENGLEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80112
Practice Address - Country:US
Practice Address - Phone:303-741-1077
Practice Address - Fax:303-741-1078
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-06
Last Update Date:2008-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Multi-Specialty
No103G00000XBehavioral Health & Social Service ProvidersClinical NeuropsychologistGroup - Multi-Specialty
No103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty
No104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Multi-Specialty
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO04010286Medicaid
CO04010286Medicaid
COA1506Medicare ID - Type Unspecified