Provider Demographics
NPI:1497451355
Name:CANYON RIDGE INTEGRATIVE HEALTH LLC
Entity Type:Organization
Organization Name:CANYON RIDGE INTEGRATIVE HEALTH LLC
Other - Org Name:CANYON RIDGE INTEGRATED HEALTH
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BRYAN
Authorized Official - Middle Name:
Authorized Official - Last Name:RUDIAK
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:303-660-3505
Mailing Address - Street 1:7280 LAGAE RD STE B
Mailing Address - Street 2:
Mailing Address - City:CASTLE PINES
Mailing Address - State:CO
Mailing Address - Zip Code:80108-9454
Mailing Address - Country:US
Mailing Address - Phone:303-660-3505
Mailing Address - Fax:
Practice Address - Street 1:7280 LAGAE RD STE B
Practice Address - Street 2:
Practice Address - City:CASTLE PINES
Practice Address - State:CO
Practice Address - Zip Code:80108-9454
Practice Address - Country:US
Practice Address - Phone:303-660-3505
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-02-02
Last Update Date:2023-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty
No261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty