Provider Demographics
NPI:1477841112
Name:PAIN REHABILITATION CENTER OF COLORADO INC
Entity Type:Organization
Organization Name:PAIN REHABILITATION CENTER OF COLORADO INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MISS
Authorized Official - First Name:MELINDA
Authorized Official - Middle Name:L
Authorized Official - Last Name:BOYD
Authorized Official - Suffix:
Authorized Official - Credentials:MSSW
Authorized Official - Phone:303-756-3405
Mailing Address - Street 1:4665 E WARREN AVE STE B
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80222-5051
Mailing Address - Country:US
Mailing Address - Phone:303-756-3405
Mailing Address - Fax:
Practice Address - Street 1:4665 E WARREN AVE STE B
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80222-5051
Practice Address - Country:US
Practice Address - Phone:303-756-3405
Practice Address - Fax:303-756-3417
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-07-15
Last Update Date:2011-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1380261QR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation