Provider Demographics
NPI:1548388325
Name:JEFFERSON HILLS CORPORATION
Entity Type:Organization
Organization Name:JEFFERSON HILLS CORPORATION
Other - Org Name:JEFFERSON HILLS LAKEWOOD
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CONTROLLER
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTINE
Authorized Official - Middle Name:
Authorized Official - Last Name:ELLIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:303-969-3822
Mailing Address - Street 1:421 ZANG ST
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80228-1052
Mailing Address - Country:US
Mailing Address - Phone:303-989-4357
Mailing Address - Fax:303-988-2017
Practice Address - Street 1:421 ZANG ST
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80228-1052
Practice Address - Country:US
Practice Address - Phone:303-989-4357
Practice Address - Fax:303-988-2017
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:JEFFERSON HILLS CORPORATION
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-03-27
Last Update Date:2014-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO88459322D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes322D00000XResidential Treatment FacilitiesResidential Treatment Facility, Emotionally Disturbed Children
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO92138845Medicaid