Provider Demographics
NPI:1417077686
Name:YOUTH VENTURES OF COLORADO
Entity Type:Organization
Organization Name:YOUTH VENTURES OF COLORADO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KENN
Authorized Official - Middle Name:
Authorized Official - Last Name:BRIGGS
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:719-574-3555
Mailing Address - Street 1:4785 GRANBY CIR
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80919-3131
Mailing Address - Country:US
Mailing Address - Phone:719-574-3555
Mailing Address - Fax:719-260-0332
Practice Address - Street 1:4785 GRANBY CIR
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80919-3131
Practice Address - Country:US
Practice Address - Phone:719-574-3555
Practice Address - Fax:719-260-0332
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-30
Last Update Date:2007-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO103570Medicaid