Provider Demographics
NPI:1659645257
Name:THE EPWORTH FOUNDATION
Entity Type:Organization
Organization Name:THE EPWORTH FOUNDATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:KING
Authorized Official - Middle Name:HEZIKIAH
Authorized Official - Last Name:HARRIS
Authorized Official - Suffix:
Authorized Official - Credentials:BS, MDIV
Authorized Official - Phone:303-296-6287
Mailing Address - Street 1:1865 BRUCE RANDOLPH AVE
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80205-4075
Mailing Address - Country:US
Mailing Address - Phone:303-296-6287
Mailing Address - Fax:303-295-7545
Practice Address - Street 1:1865 BRUCE RANDOLPH AVE
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80205-4075
Practice Address - Country:US
Practice Address - Phone:303-296-6287
Practice Address - Fax:303-295-7545
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-28
Last Update Date:2012-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1555251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health