Provider Demographics
NPI:1356644330
Name:IDEA FORUM-AURORA
Entity Type:Organization
Organization Name:IDEA FORUM-AURORA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:MARCELA
Authorized Official - Middle Name:M
Authorized Official - Last Name:PAIZ
Authorized Official - Suffix:
Authorized Official - Credentials:BS,CAC III
Authorized Official - Phone:303-477-8280
Mailing Address - Street 1:1090 S SABLE BLVD
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80012-3796
Mailing Address - Country:US
Mailing Address - Phone:720-858-9111
Mailing Address - Fax:
Practice Address - Street 1:1090 S SABLE BLVD
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80012-3796
Practice Address - Country:US
Practice Address - Phone:720-858-9111
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:IDEA FORUM, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-12-13
Last Update Date:2010-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COADAD 0843251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO66537576Medicaid