Provider Demographics
NPI:1316189376
Name:CEREHEALTH CORP.
Entity Type:Organization
Organization Name:CEREHEALTH CORP.
Other - Org Name:CERESCAN CORP.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHAIR/CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:KELLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:720-242-9081
Mailing Address - Street 1:991 SOUTHPARK DR
Mailing Address - Street 2:STE. 200
Mailing Address - City:LITTLETON
Mailing Address - State:CO
Mailing Address - Zip Code:80120-5688
Mailing Address - Country:US
Mailing Address - Phone:720-242-9081
Mailing Address - Fax:303-648-6558
Practice Address - Street 1:991 SOUTHPARK DR
Practice Address - Street 2:STE. 200
Practice Address - City:LITTLETON
Practice Address - State:CO
Practice Address - Zip Code:80120-5688
Practice Address - Country:US
Practice Address - Phone:720-242-9081
Practice Address - Fax:303-648-6558
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-06
Last Update Date:2015-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1157-01261QR0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology