Provider Demographics
NPI:1558964734
Name:INNER CITY HEALTH CENTER
Entity Type:Organization
Organization Name:INNER CITY HEALTH CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPERATIONS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KARINA
Authorized Official - Middle Name:OLIVIA
Authorized Official - Last Name:VILLAGRANA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:303-296-1767
Mailing Address - Street 1:3800 N YORK ST
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80205-3540
Mailing Address - Country:US
Mailing Address - Phone:303-296-1767
Mailing Address - Fax:
Practice Address - Street 1:2301 LAWRENCE ST
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80205-2126
Practice Address - Country:US
Practice Address - Phone:303-296-1767
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:INNER CITY HEALTH CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-11-19
Last Update Date:2023-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223D0001XDental ProvidersDentistDental Public HealthGroup - Multi-Specialty
No2083P0901XAllopathic & Osteopathic PhysiciansPreventive MedicinePublic Health & General Preventive MedicineGroup - Multi-Specialty
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)Group - Multi-Specialty