Provider Demographics
NPI:1912554668
Name:DENVER RECOVERY GROUP LLC
Entity Type:Organization
Organization Name:DENVER RECOVERY GROUP LLC
Other - Org Name:DENVER RECOVERY GROUP - WEST
Other - Org Type:Other Name
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KARLA
Authorized Official - Middle Name:
Authorized Official - Last Name:CHAVEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:575-993-5225
Mailing Address - Street 1:5330 MANHATTAN CIR STE H
Mailing Address - Street 2:
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80303-4240
Mailing Address - Country:US
Mailing Address - Phone:720-536-5571
Mailing Address - Fax:
Practice Address - Street 1:5330 MANHATTAN CIR STE H
Practice Address - Street 2:
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80303-4240
Practice Address - Country:US
Practice Address - Phone:720-536-5571
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DENVER RECOVERY GROUP LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-08-19
Last Update Date:2020-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM2800XAmbulatory Health Care FacilitiesClinic/CenterMethadone
Yes207QA0401XAllopathic & Osteopathic PhysiciansFamily MedicineAddiction MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO9000141712Medicaid
CO9000148295Medicaid