Provider Demographics
NPI:1558727883
Name:METRO COMMUNITY PROVIDER NETWORK INC
Entity Type:Organization
Organization Name:METRO COMMUNITY PROVIDER NETWORK INC
Other - Org Name:STRIDE CHC - DEL MAR
Other - Org Type:Other Name
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:APRIL
Authorized Official - Middle Name:
Authorized Official - Last Name:PEER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:303-761-1977
Mailing Address - Street 1:7495 W 29TH AVE
Mailing Address - Street 2:
Mailing Address - City:WHEAT RIDGE
Mailing Address - State:CO
Mailing Address - Zip Code:80033-8002
Mailing Address - Country:US
Mailing Address - Phone:303-761-1977
Mailing Address - Fax:303-343-0247
Practice Address - Street 1:10680 DEL MAR PARKWAY
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80010-4011
Practice Address - Country:US
Practice Address - Phone:303-360-6276
Practice Address - Fax:303-789-7222
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:METRO COMMUNITY PROVIDER NETWORK INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-12-31
Last Update Date:2024-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO261QF0400X, 261QF0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO49105060Medicaid