Provider Demographics
NPI:1457449951
Name:RMCHS MANAGEMENT
Entity Type:Organization
Organization Name:RMCHS MANAGEMENT
Other - Org Name:THE CHILDREN'S HOSPITAL PEDIATRIC DENTISTRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR, AMBULATORY PRACTICE
Authorized Official - Prefix:
Authorized Official - First Name:JANINE
Authorized Official - Middle Name:
Authorized Official - Last Name:COSTANTINI
Authorized Official - Suffix:
Authorized Official - Credentials:MHSA
Authorized Official - Phone:720-777-3951
Mailing Address - Street 1:13123 E 16TH AVE
Mailing Address - Street 2:B240
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80045-7106
Mailing Address - Country:US
Mailing Address - Phone:303-861-6788
Mailing Address - Fax:303-837-2809
Practice Address - Street 1:13123 E 16TH AVE
Practice Address - Street 2:B240
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80045-7106
Practice Address - Country:US
Practice Address - Phone:303-861-6788
Practice Address - Fax:303-837-2809
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-10
Last Update Date:2011-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO85191223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO04004560Medicaid