Provider Demographics
NPI:1457008526
Name:RECOVERY VILLAGE AT PALMER LAKE, LLC
Entity Type:Organization
Organization Name:RECOVERY VILLAGE AT PALMER LAKE, LLC
Other - Org Name:DENVER MENTAL HEALTH AND COUNSELING BY THE RECOVERY VILLAGE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CONTRACTING & LICENSING DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:BELINA
Authorized Official - Middle Name:
Authorized Official - Last Name:SURUJON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:754-300-3120
Mailing Address - Street 1:100 SE 3RD AVE STE 1800
Mailing Address - Street 2:
Mailing Address - City:FT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33394-0011
Mailing Address - Country:US
Mailing Address - Phone:754-300-3120
Mailing Address - Fax:888-919-4431
Practice Address - Street 1:630 PLAZA DR
Practice Address - Street 2:
Practice Address - City:HIGHLANDS RANCH
Practice Address - State:CO
Practice Address - Zip Code:80129-2379
Practice Address - Country:US
Practice Address - Phone:754-300-3120
Practice Address - Fax:888-919-4431
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:THE RECOVERY VILLAGE PALMER LAKE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-03-08
Last Update Date:2023-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)