Provider Demographics
NPI:1356471718
Name:TENNYSON CENTER FOR CHILDREN
Entity Type:Organization
Organization Name:TENNYSON CENTER FOR CHILDREN
Other - Org Name:TENNYSON CENTER FOR CHILDREN AT COLORADO CHRISTIAN HOME
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:MINDY
Authorized Official - Middle Name:
Authorized Official - Last Name:WATROUS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:619-890-8697
Mailing Address - Street 1:2950 TENNYSON ST
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80212
Mailing Address - Country:US
Mailing Address - Phone:303-433-2541
Mailing Address - Fax:303-433-9701
Practice Address - Street 1:2950 TENNYSON ST
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80212
Practice Address - Country:US
Practice Address - Phone:303-433-2541
Practice Address - Fax:303-433-9701
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-06
Last Update Date:2024-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1529814322D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes322D00000XResidential Treatment FacilitiesResidential Treatment Facility, Emotionally Disturbed Children
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO32900350Medicaid