Provider Demographics
NPI:1497874200
Name:NAMAQUA CENTER
Entity Type:Organization
Organization Name:NAMAQUA CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:CYNDI
Authorized Official - Middle Name:
Authorized Official - Last Name:DODDS
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:970-690-7550
Mailing Address - Street 1:404 E 7TH ST
Mailing Address - Street 2:
Mailing Address - City:LOVELAND
Mailing Address - State:CO
Mailing Address - Zip Code:80537-4804
Mailing Address - Country:US
Mailing Address - Phone:970-669-7550
Mailing Address - Fax:970-663-2907
Practice Address - Street 1:404 E 7TH ST
Practice Address - Street 2:
Practice Address - City:LOVELAND
Practice Address - State:CO
Practice Address - Zip Code:80537-4804
Practice Address - Country:US
Practice Address - Phone:970-669-7550
Practice Address - Fax:970-663-2907
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-29
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO45142322D00000X
CO100889322D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes322D00000XResidential Treatment FacilitiesResidential Treatment Facility, Emotionally Disturbed Children
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO93826753Medicare UPIN
CO73275557Medicare UPIN
CO01310903Medicare UPIN
CO24109053Medicare UPIN
CO57631361Medicare UPIN
CO37072269Medicare UPIN