Provider Demographics
NPI:1992177596
Name:MOUNTAIN CREST BEHAVIORAL HEALTH HOSPITAL
Entity Type:Organization
Organization Name:MOUNTAIN CREST BEHAVIORAL HEALTH HOSPITAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROFESSIONAL MENTAL HEALTH PROFESSI
Authorized Official - Prefix:
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:
Authorized Official - Last Name:WENTE
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:970-207-4820
Mailing Address - Street 1:4601 CORBETT DR
Mailing Address - Street 2:
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80528-9579
Mailing Address - Country:US
Mailing Address - Phone:970-207-4800
Mailing Address - Fax:
Practice Address - Street 1:4601 CORBETT DR
Practice Address - Street 2:
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80528-9579
Practice Address - Country:US
Practice Address - Phone:970-207-4800
Practice Address - Fax:970-207-4855
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:POUDRE VALLEY HOSPITAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-10-22
Last Update Date:2015-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO00993063283Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes283Q00000XHospitalsPsychiatric Hospital