Provider Demographics
NPI:1003534090
Name:ALIS BEHAVIORAL HEALTH OF COLORADO LLC
Entity type:Organization
Organization Name:ALIS BEHAVIORAL HEALTH OF COLORADO LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:ELI
Authorized Official - Middle Name:
Authorized Official - Last Name:GROSS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:888-528-3860
Mailing Address - Street 1:1325 S COLORADO BLVD STE B705
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80222-3383
Mailing Address - Country:US
Mailing Address - Phone:888-528-3860
Mailing Address - Fax:
Practice Address - Street 1:1325 S COLORADO BLVD STE B705
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80222-3383
Practice Address - Country:US
Practice Address - Phone:888-528-3860
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-08-16
Last Update Date:2023-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO9000208795Medicaid