Provider Demographics
NPI:1598031692
Name:ASPEN CENTERS FOR ADVANCED TREATMENT
Entity Type:Organization
Organization Name:ASPEN CENTERS FOR ADVANCED TREATMENT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JONATHAN
Authorized Official - Middle Name:D
Authorized Official - Last Name:BIRNKRANT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:970-300-1845
Mailing Address - Street 1:100 E MAIN ST
Mailing Address - Street 2:SUITE 202
Mailing Address - City:ASPEN
Mailing Address - State:CO
Mailing Address - Zip Code:81611-1780
Mailing Address - Country:US
Mailing Address - Phone:970-300-1845
Mailing Address - Fax:970-300-1846
Practice Address - Street 1:100 E MAIN ST
Practice Address - Street 2:SUITE 202
Practice Address - City:ASPEN
Practice Address - State:CO
Practice Address - Zip Code:81611-1780
Practice Address - Country:US
Practice Address - Phone:970-300-1845
Practice Address - Fax:970-300-1846
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-22
Last Update Date:2012-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO4679164W00000X
CO455392084P0800X, 2084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent PsychiatryGroup - Single Specialty
No164W00000XNursing Service ProvidersLicensed Practical NurseGroup - Single Specialty
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty