Provider Demographics
NPI:1326216581
Name:MOUNT SAINT VINCENT HOME
Entity Type:Organization
Organization Name:MOUNT SAINT VINCENT HOME
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:KIRK
Authorized Official - Middle Name:DAMON
Authorized Official - Last Name:WARD
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:303-458-7220
Mailing Address - Street 1:4159 LOWELL BLVD
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80211-1658
Mailing Address - Country:US
Mailing Address - Phone:303-458-7220
Mailing Address - Fax:303-477-7559
Practice Address - Street 1:4159 LOWELL BLVD
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80211-1658
Practice Address - Country:US
Practice Address - Phone:303-458-7220
Practice Address - Fax:303-477-7559
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-11
Last Update Date:2008-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO992938322D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes322D00000XResidential Treatment FacilitiesResidential Treatment Facility, Emotionally Disturbed Children