Provider Demographics
NPI:1720399835
Name:DENVER HEALTH AUTHORITY
Entity Type:Organization
Organization Name:DENVER HEALTH AUTHORITY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CAC III
Authorized Official - Prefix:
Authorized Official - First Name:AMANDA
Authorized Official - Middle Name:CHRISTINE
Authorized Official - Last Name:DONOVAN
Authorized Official - Suffix:
Authorized Official - Credentials:ADDICTIONS
Authorized Official - Phone:303-436-5632
Mailing Address - Street 1:777 BANNOCK ST UNIT 9
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80204-4507
Mailing Address - Country:US
Mailing Address - Phone:303-436-5632
Mailing Address - Fax:303-436-5071
Practice Address - Street 1:777 BANNOCK ST UNIT 9
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80204-4507
Practice Address - Country:US
Practice Address - Phone:303-436-5632
Practice Address - Fax:303-436-5071
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-24
Last Update Date:2010-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO6426276400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes276400000XHospital UnitsRehabilitation, Substance Use Disorder Unit