Provider Demographics
NPI:1790162451
Name:ADOLESCENT HEALTHCARE ASSOCIATES OF COLORADO
Entity Type:Organization
Organization Name:ADOLESCENT HEALTHCARE ASSOCIATES OF COLORADO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER AND PROVIDER OF LLC
Authorized Official - Prefix:MS
Authorized Official - First Name:MARGARET
Authorized Official - Middle Name:JEAN
Authorized Official - Last Name:WEAR
Authorized Official - Suffix:
Authorized Official - Credentials:MSN FNP-C
Authorized Official - Phone:970-230-9315
Mailing Address - Street 1:214 8TH ST
Mailing Address - Street 2:SUITE 205
Mailing Address - City:GLENWOOD SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:81601-3326
Mailing Address - Country:US
Mailing Address - Phone:970-230-9315
Mailing Address - Fax:970-230-9427
Practice Address - Street 1:214 8TH ST
Practice Address - Street 2:SUITE 205
Practice Address - City:GLENWOOD SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:81601-3326
Practice Address - Country:US
Practice Address - Phone:970-230-9315
Practice Address - Fax:970-230-9427
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-05-01
Last Update Date:2015-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0078099261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care