Provider Demographics
NPI:1235734781
Name:REGENTS OF THE UNIVERSITY OF COLORADO
Entity Type:Organization
Organization Name:REGENTS OF THE UNIVERSITY OF COLORADO
Other - Org Name:PARKSIDE CLINIC ARTS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ARTS DIRECTOR OF OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:ANGI
Authorized Official - Middle Name:
Authorized Official - Last Name:WOLD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:303-734-3317
Mailing Address - Street 1:3738 W PRINCETON CIR
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80236-3110
Mailing Address - Country:US
Mailing Address - Phone:303-761-6703
Mailing Address - Fax:
Practice Address - Street 1:1620 GAYLORD ST
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80206-1207
Practice Address - Country:US
Practice Address - Phone:303-761-6703
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:REGENTS OF THE UNIVERSITY OF COLORADO
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-12-02
Last Update Date:2022-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use DisorderGroup - Multi-Specialty
No103TA0400XBehavioral Health & Social Service ProvidersPsychologistAddiction (Substance Use Disorder)Group - Multi-Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No207RA0401XAllopathic & Osteopathic PhysiciansInternal MedicineAddiction MedicineGroup - Multi-Specialty
No2084A0401XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyAddiction MedicineGroup - Multi-Specialty
No251S00000XAgenciesCommunity/Behavioral Health
No261QM2800XAmbulatory Health Care FacilitiesClinic/CenterMethadone
No364SP0808XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO9000141345Medicaid