Provider Demographics
NPI:1861637829
Name:NORTH COLORADO MEDICAL CENTER BEHAVIORAL HEALTH
Entity Type:Organization
Organization Name:NORTH COLORADO MEDICAL CENTER BEHAVIORAL HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:INTAKE AND ASSESSMENT THERAPIST
Authorized Official - Prefix:MISS
Authorized Official - First Name:POLLY
Authorized Official - Middle Name:ANNE
Authorized Official - Last Name:SHATTUCK
Authorized Official - Suffix:
Authorized Official - Credentials:MSW
Authorized Official - Phone:970-336-4908
Mailing Address - Street 1:16 OAK ST
Mailing Address - Street 2:
Mailing Address - City:WINDSOR
Mailing Address - State:CO
Mailing Address - Zip Code:80550-5434
Mailing Address - Country:US
Mailing Address - Phone:970-460-0179
Mailing Address - Fax:
Practice Address - Street 1:928 12TH ST
Practice Address - Street 2:
Practice Address - City:GREELEY
Practice Address - State:CO
Practice Address - Zip Code:80631-4024
Practice Address - Country:US
Practice Address - Phone:970-336-4908
Practice Address - Fax:970-336-5000
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NORTH COLORADO MEDICAL CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-12-04
Last Update Date:2008-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes283Q00000XHospitalsPsychiatric Hospital