Provider Demographics
NPI:1164121547
Name:TENNYSON CENTER FOR CHILDREN AT COLORADO CHRISTIAN HOME
Entity Type:Organization
Organization Name:TENNYSON CENTER FOR CHILDREN AT COLORADO CHRISTIAN HOME
Other - Org Name:TENNYSON CENTER FOR CHILDREN
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:MINDY
Authorized Official - Middle Name:
Authorized Official - Last Name:WATROUS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:196-890-8697
Mailing Address - Street 1:2950 TENNYSON ST
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80212-3029
Mailing Address - Country:US
Mailing Address - Phone:303-433-2541
Mailing Address - Fax:
Practice Address - Street 1:2950 TENNYSON ST
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80212-3029
Practice Address - Country:US
Practice Address - Phone:303-433-2541
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-02-24
Last Update Date:2024-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO9000226180Medicaid