Provider Demographics
NPI:1821319112
Name:EDELEN ENTERPRISES, INC. D/B/A RECOVERY 360
Entity Type:Organization
Organization Name:EDELEN ENTERPRISES, INC. D/B/A RECOVERY 360
Other - Org Name:EDELEN ENTERPRISES, INC. D/B/A BLUE PINE RECOVERY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:RONNY
Authorized Official - Middle Name:M
Authorized Official - Last Name:DE CARLO
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT, LAC, LPC
Authorized Official - Phone:720-854-5959
Mailing Address - Street 1:7350 E. PROGRESS PLACE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:GREENWOOD VILLAGE
Mailing Address - State:CO
Mailing Address - Zip Code:80111-2130
Mailing Address - Country:US
Mailing Address - Phone:720-854-5959
Mailing Address - Fax:
Practice Address - Street 1:7350 E. PROGRESS PLACE
Practice Address - Street 2:SUITE 100
Practice Address - City:GREENWOOD VILLAGE
Practice Address - State:CO
Practice Address - Zip Code:80111-2130
Practice Address - Country:US
Practice Address - Phone:720-854-5959
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-21
Last Update Date:2020-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No251S00000XAgenciesCommunity/Behavioral HealthGroup - Multi-Specialty