Provider Demographics
NPI:1386183010
Name:KHESED WELLNESS A COLORADO NONPROFIT CORPORATION
Entity Type:Organization
Organization Name:KHESED WELLNESS A COLORADO NONPROFIT CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:HEATHER
Authorized Official - Middle Name:
Authorized Official - Last Name:NELSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:972-523-4921
Mailing Address - Street 1:2255 SHERIDAN BLVD
Mailing Address - Street 2:UNIT C, SUITE 224
Mailing Address - City:EDGEWATER
Mailing Address - State:CO
Mailing Address - Zip Code:80214
Mailing Address - Country:US
Mailing Address - Phone:720-575-9889
Mailing Address - Fax:
Practice Address - Street 1:3401 W 29TH AVE
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80211-3611
Practice Address - Country:US
Practice Address - Phone:720-575-9889
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-14
Last Update Date:2019-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO9000150039Medicaid