Provider Demographics
NPI:1952843815
Name:ASPENRIDGE NORTH
Entity Type:Organization
Organization Name:ASPENRIDGE NORTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:ALEX
Authorized Official - Middle Name:
Authorized Official - Last Name:LOUCKS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:970-875-6116
Mailing Address - Street 1:706 S COLLEGE AVE STE 201&202
Mailing Address - Street 2:
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80524-9817
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:706 S COLLEGE AVE STE 201&202
Practice Address - Street 2:
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80524-9817
Practice Address - Country:US
Practice Address - Phone:928-277-7209
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ASPENRIDGE RECOVERY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-11-09
Last Update Date:2021-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1774-00324500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO1774-01OtherLICENSE