Provider Demographics
NPI:1922695741
Name:FRONT RANGE BEHAVIOR
Entity Type:Organization
Organization Name:FRONT RANGE BEHAVIOR
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ANGELA
Authorized Official - Middle Name:B
Authorized Official - Last Name:CHASE
Authorized Official - Suffix:
Authorized Official - Credentials:BCBA, MS, CCC-SLP
Authorized Official - Phone:970-673-8476
Mailing Address - Street 1:2547 11TH AVE STE B
Mailing Address - Street 2:
Mailing Address - City:GREELEY
Mailing Address - State:CO
Mailing Address - Zip Code:80631-1680
Mailing Address - Country:US
Mailing Address - Phone:970-673-8476
Mailing Address - Fax:970-515-3619
Practice Address - Street 1:2547 11TH AVE STE B
Practice Address - Street 2:
Practice Address - City:GREELEY
Practice Address - State:CO
Practice Address - Zip Code:80631-1680
Practice Address - Country:US
Practice Address - Phone:970-673-8476
Practice Address - Fax:970-515-3619
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:EAST GREELEY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-12-28
Last Update Date:2020-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO9000166702Medicaid