Provider Demographics
NPI:1457494304
Name:POUDRE VALLEY HEALTH CARE INC
Entity Type:Organization
Organization Name:POUDRE VALLEY HEALTH CARE INC
Other - Org Name:MOUNTAIN CREST BEHAVIORAL SERVICES
Other - Org Type:Other Name
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:THOMPSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:970-495-7000
Mailing Address - Street 1:7901 E. LOWRY BLVD
Mailing Address - Street 2:F402, 3RD FLOOR
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80230
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4601 CORBETT DR
Practice Address - Street 2:
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80528-9579
Practice Address - Country:US
Practice Address - Phone:970-207-4800
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:POUDRE VALLEY HEALTH CARE INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-02-14
Last Update Date:2024-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
COCE9908Medicare PIN