Provider Demographics
NPI:1821154295
Name:HAND UP HOMES FOR YOUTH
Entity Type:Organization
Organization Name:HAND UP HOMES FOR YOUTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROGRAM DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:MERI
Authorized Official - Middle Name:
Authorized Official - Last Name:MIYASAKI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:970-255-8000
Mailing Address - Street 1:PO BOX 130
Mailing Address - Street 2:
Mailing Address - City:WHITEWATER
Mailing Address - State:CO
Mailing Address - Zip Code:81527-0130
Mailing Address - Country:US
Mailing Address - Phone:970-255-8000
Mailing Address - Fax:970-255-9199
Practice Address - Street 1:801 COFFMAN ROAD
Practice Address - Street 2:
Practice Address - City:WHITEWATER
Practice Address - State:CO
Practice Address - Zip Code:81527
Practice Address - Country:US
Practice Address - Phone:970-255-8000
Practice Address - Fax:970-255-9199
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-29
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO322D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes322D00000XResidential Treatment FacilitiesResidential Treatment Facility, Emotionally Disturbed Children
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO63671841Medicaid