Provider Demographics
NPI:1376272377
Name:CHILDREN'S TRAUMA CENTER, LLC
Entity Type:Organization
Organization Name:CHILDREN'S TRAUMA CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:R
Authorized Official - Last Name:BLACKWELL
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:720-262-1279
Mailing Address - Street 1:26719 PLEASANT PARK RD STE 120
Mailing Address - Street 2:
Mailing Address - City:CONIFER
Mailing Address - State:CO
Mailing Address - Zip Code:80433-7753
Mailing Address - Country:US
Mailing Address - Phone:720-262-1279
Mailing Address - Fax:
Practice Address - Street 1:26719 PLEASANT PARK RD, STE 120
Practice Address - Street 2:
Practice Address - City:CONIFER
Practice Address - State:CO
Practice Address - Zip Code:80433-7753
Practice Address - Country:US
Practice Address - Phone:720-262-1279
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-06-07
Last Update Date:2022-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty