Provider Demographics
NPI:1841584919
Name:BUFFALO RUN GROUP HOME, INC.
Entity Type:Organization
Organization Name:BUFFALO RUN GROUP HOME, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:
Authorized Official - Last Name:WILSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:303-318-0311
Mailing Address - Street 1:PO BOX 740699
Mailing Address - Street 2:
Mailing Address - City:ARVADA
Mailing Address - State:CO
Mailing Address - Zip Code:80006-0699
Mailing Address - Country:US
Mailing Address - Phone:303-318-0311
Mailing Address - Fax:303-318-0288
Practice Address - Street 1:14459 COUNTY ROAD 18 1/2
Practice Address - Street 2:
Practice Address - City:FORT LUPTON
Practice Address - State:CO
Practice Address - Zip Code:80621-9211
Practice Address - Country:US
Practice Address - Phone:303-318-0311
Practice Address - Fax:303-318-0288
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-06
Last Update Date:2011-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health