Provider Demographics
NPI:1851417679
Name:MILE HIGH COUNCIL ON ALCOHOLISM AND DRUG ABUSE
Entity Type:Organization
Organization Name:MILE HIGH COUNCIL ON ALCOHOLISM AND DRUG ABUSE
Other - Org Name:MILE HIGH BEHAVIORAL HEALTHCARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:E
Authorized Official - Last Name:DORSHIMER
Authorized Official - Suffix:
Authorized Official - Credentials:MA,ED, CACIII
Authorized Official - Phone:303-825-8113
Mailing Address - Street 1:PO BOX 919
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80040-0919
Mailing Address - Country:US
Mailing Address - Phone:303-825-8113
Mailing Address - Fax:303-825-8166
Practice Address - Street 1:4242 DELAWARE ST
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80216
Practice Address - Country:US
Practice Address - Phone:303-825-8113
Practice Address - Fax:303-825-8166
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-22
Last Update Date:2020-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1283-000101YA0400X, 251B00000X, 251S00000X, 251V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
No251B00000XAgenciesCase Management
No251S00000XAgenciesCommunity/Behavioral Health
No251V00000XAgenciesVoluntary or CharitableGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO63634368Medicaid