Provider Demographics
NPI:1689721730
Name:SEVEN LAKES RECOVERY PROGRAM
Entity Type:Organization
Organization Name:SEVEN LAKES RECOVERY PROGRAM
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:
Authorized Official - Last Name:ASH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:970-495-4684
Mailing Address - Street 1:128 N. 6TH ST.
Mailing Address - Street 2:UNIT D
Mailing Address - City:WINDSOR
Mailing Address - State:CO
Mailing Address - Zip Code:80550
Mailing Address - Country:US
Mailing Address - Phone:970-495-4684
Mailing Address - Fax:970-674-3309
Practice Address - Street 1:128 N. 6TH ST.
Practice Address - Street 2:UNIT D
Practice Address - City:WINDSOR
Practice Address - State:CO
Practice Address - Zip Code:80550
Practice Address - Country:US
Practice Address - Phone:970-495-4684
Practice Address - Fax:970-674-3309
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1179-00101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty