Provider Demographics
NPI:1356608129
Name:QUIET RIVER ADDICTION CENTER
Entity type:Organization
Organization Name:QUIET RIVER ADDICTION CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:SKYE
Authorized Official - Middle Name:
Authorized Official - Last Name:FORREST
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:310-774-1323
Mailing Address - Street 1:2500 ARAPAHOE ST
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80205-2616
Mailing Address - Country:US
Mailing Address - Phone:720-920-9750
Mailing Address - Fax:720-583-0886
Practice Address - Street 1:2500 ARAPAHOE ST
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80205-2616
Practice Address - Country:US
Practice Address - Phone:720-920-9750
Practice Address - Fax:720-583-0886
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-18
Last Update Date:2013-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility