Provider Demographics
NPI:1477882504
Name:NARCONON CO
Entity Type:Organization
Organization Name:NARCONON CO
Other - Org Name:A LIFE WORTH LIVING
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:GLEN
Authorized Official - Middle Name:
Authorized Official - Last Name:PETCAVAGE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-587-7771
Mailing Address - Street 1:1225 REDWOOD ST
Mailing Address - Street 2:
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80524-2052
Mailing Address - Country:US
Mailing Address - Phone:954-587-7771
Mailing Address - Fax:954-208-5770
Practice Address - Street 1:1225 REDWOOD ST
Practice Address - Street 2:
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80524-2052
Practice Address - Country:US
Practice Address - Phone:954-587-7771
Practice Address - Fax:954-208-5770
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-12-21
Last Update Date:2010-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO324500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility