Provider Demographics
NPI:1417434176
Name:EPIDAURUS
Entity Type:Organization
Organization Name:EPIDAURUS
Other - Org Name:AMITY FOUNDATION
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR OF GRANT DEVELOPMENT
Authorized Official - Prefix:
Authorized Official - First Name:OLGA
Authorized Official - Middle Name:
Authorized Official - Last Name:MELLIZO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:970-889-2351
Mailing Address - Street 1:1312 HASTINGS DR
Mailing Address - Street 2:
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80526-2453
Mailing Address - Country:US
Mailing Address - Phone:970-889-2351
Mailing Address - Fax:
Practice Address - Street 1:2260 WATSON WAY
Practice Address - Street 2:
Practice Address - City:VISTA
Practice Address - State:CA
Practice Address - Zip Code:92083-7924
Practice Address - Country:US
Practice Address - Phone:760-559-1802
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-07-25
Last Update Date:2018-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder