Provider Demographics
NPI:1245849736
Name:CHILDREN'S WELLNESS CENTER OF COLORADO
Entity type:Organization
Organization Name:CHILDREN'S WELLNESS CENTER OF COLORADO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COOWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTINE
Authorized Official - Middle Name:WERNER
Authorized Official - Last Name:GARCIA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:720-662-7862
Mailing Address - Street 1:12150 E BRIARWOOD AVE UNIT 202
Mailing Address - Street 2:
Mailing Address - City:CENTENNIAL
Mailing Address - State:CO
Mailing Address - Zip Code:80112-6755
Mailing Address - Country:US
Mailing Address - Phone:720-662-7862
Mailing Address - Fax:720-573-2862
Practice Address - Street 1:2220 CURVE PLAZA
Practice Address - Street 2:SUITE 203
Practice Address - City:STEAMBOAT SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80487
Practice Address - Country:US
Practice Address - Phone:720-662-7862
Practice Address - Fax:720-573-2862
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-07-30
Last Update Date:2020-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO60125080Medicaid
CO60155080Medicaid