Provider Demographics
NPI:1790328607
Name:GALLUS DETOX DENVER LLC
Entity Type:Organization
Organization Name:GALLUS DETOX DENVER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF CLINICAL OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:GEORGINA
Authorized Official - Middle Name:
Authorized Official - Last Name:CARROLL
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:928-533-0872
Mailing Address - Street 1:300 S JACKSON ST STE 220
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80209-3134
Mailing Address - Country:US
Mailing Address - Phone:855-338-6929
Mailing Address - Fax:866-565-8393
Practice Address - Street 1:5920 S ESTES ST STE 150
Practice Address - Street 2:
Practice Address - City:LITTLETON
Practice Address - State:CO
Practice Address - Zip Code:80123-8620
Practice Address - Country:US
Practice Address - Phone:855-338-6929
Practice Address - Fax:866-565-8393
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-10-23
Last Update Date:2023-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility