Provider Demographics
NPI:1376949867
Name:COLORADO PROFESSIONAL RECOVERY INC.
Entity Type:Organization
Organization Name:COLORADO PROFESSIONAL RECOVERY INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP OF OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:LEONARD
Authorized Official - Middle Name:
Authorized Official - Last Name:SOLANO
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:303-456-4882
Mailing Address - Street 1:4990 KIPLING ST
Mailing Address - Street 2:SUITE B-5
Mailing Address - City:WHEAT RIDGE
Mailing Address - State:CO
Mailing Address - Zip Code:80033-6762
Mailing Address - Country:US
Mailing Address - Phone:303-456-4882
Mailing Address - Fax:
Practice Address - Street 1:4990 KIPLING ST
Practice Address - Street 2:SUITE B-5
Practice Address - City:WHEAT RIDGE
Practice Address - State:CO
Practice Address - Zip Code:80033-6762
Practice Address - Country:US
Practice Address - Phone:303-456-4882
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-11-10
Last Update Date:2014-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO37144207QA0401X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QA0401XAllopathic & Osteopathic PhysiciansFamily MedicineAddiction MedicineGroup - Single Specialty