Provider Demographics
NPI:1710519848
Name:CENTURA VENTURES, LLC
Entity Type:Organization
Organization Name:CENTURA VENTURES, LLC
Other - Org Name:CS CHURCH RANCH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VP, AMBULATORY SERVICES
Authorized Official - Prefix:MS
Authorized Official - First Name:DEBRA
Authorized Official - Middle Name:
Authorized Official - Last Name:CARPENTER
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:303-765-6998
Mailing Address - Street 1:PO BOX 801172
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64180-1172
Mailing Address - Country:US
Mailing Address - Phone:800-953-0104
Mailing Address - Fax:303-765-6670
Practice Address - Street 1:7233 CHURCH RANCH BLVD
Practice Address - Street 2:
Practice Address - City:WESTMINSTER
Practice Address - State:CO
Practice Address - Zip Code:80021-4094
Practice Address - Country:US
Practice Address - Phone:303-925-4137
Practice Address - Fax:303-925-4143
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-02-06
Last Update Date:2021-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO98431382Medicaid
1073882197OtherOLD NPI