Provider Demographics
NPI:1710080171
Name:PORTER ADVENTIST HEALTH SYSTEM
Entity Type:Organization
Organization Name:PORTER ADVENTIST HEALTH SYSTEM
Other - Org Name:PORTER HOSPICE AT THE JOHNSON CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:DAN
Authorized Official - Middle Name:
Authorized Official - Last Name:ENDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:303-643-1235
Mailing Address - Street 1:1391 SPEER BLVD
Mailing Address - Street 2:SUITE 600
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80204-2508
Mailing Address - Country:US
Mailing Address - Phone:303-561-5000
Mailing Address - Fax:303-561-5050
Practice Address - Street 1:5020 E ARAPAHOE RD
Practice Address - Street 2:
Practice Address - City:LITTLETON
Practice Address - State:CO
Practice Address - Zip Code:80122-2302
Practice Address - Country:US
Practice Address - Phone:303-694-3545
Practice Address - Fax:303-694-5103
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-07
Last Update Date:2023-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0696251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO05800198Medicaid
CO05800198Medicaid