Provider Demographics
NPI:1225557523
Name:BELK MODEL LLC
Entity Type:Organization
Organization Name:BELK MODEL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:DENISE
Authorized Official - Middle Name:
Authorized Official - Last Name:BELK
Authorized Official - Suffix:
Authorized Official - Credentials:PHD, MSW
Authorized Official - Phone:720-526-2355
Mailing Address - Street 1:PO BOX 271274
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:CO
Mailing Address - Zip Code:80027-5024
Mailing Address - Country:US
Mailing Address - Phone:720-526-2355
Mailing Address - Fax:
Practice Address - Street 1:1940 GARLAND ST
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80215-2973
Practice Address - Country:US
Practice Address - Phone:720-526-2355
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-09-18
Last Update Date:2017-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities