Provider Demographics
NPI:1508447665
Name:POUDRE VALLEY HEALTH CARE INC.
Entity Type:Organization
Organization Name:POUDRE VALLEY HEALTH CARE INC.
Other - Org Name:UCHEALTH MOUNTAIN CREST BEHAVIORAL HEALTH - OUTREACH
Other - Org Type:Other Name
Authorized Official - Title/Position:CFO, NORTHERN CO
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:MAIL STOP F402
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80230-6507
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3519 RICHMOND DR
Practice Address - Street 2:
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80526-5995
Practice Address - Country:US
Practice Address - Phone:970-207-4864
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:POUDRE VALLEY HEALTH CARE INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-04-19
Last Update Date:2024-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)