Provider Demographics
NPI:1376024968
Name:URBAN PEAKS REHAB, LLC
Entity Type:Organization
Organization Name:URBAN PEAKS REHAB, LLC
Other - Org Name:URBAN PEAKS REHAB
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:CHAD
Authorized Official - Middle Name:R
Authorized Official - Last Name:JOHNSTON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:303-955-5131
Mailing Address - Street 1:1490 N LAFAYETTE ST
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80218-2339
Mailing Address - Country:US
Mailing Address - Phone:303-955-5131
Mailing Address - Fax:303-955-5181
Practice Address - Street 1:1490 N LAFAYETTE ST
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80218-2339
Practice Address - Country:US
Practice Address - Phone:303-955-5131
Practice Address - Fax:303-955-5181
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-08-22
Last Update Date:2018-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RA0401XAllopathic & Osteopathic PhysiciansInternal MedicineAddiction MedicineGroup - Single Specialty