Provider Demographics
NPI:1396510426
Name:HAWTHORNE MENTAL HEALTH LLC
Entity type:Organization
Organization Name:HAWTHORNE MENTAL HEALTH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:GEOFREY
Authorized Official - Middle Name:
Authorized Official - Last Name:KOSGEI
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:719-502-7832
Mailing Address - Street 1:7217 ALPINE DAISY DR
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80925-9611
Mailing Address - Country:US
Mailing Address - Phone:719-502-7832
Mailing Address - Fax:
Practice Address - Street 1:503 N MAIN ST STE 658
Practice Address - Street 2:
Practice Address - City:PUEBLO
Practice Address - State:CO
Practice Address - Zip Code:81003-3132
Practice Address - Country:US
Practice Address - Phone:719-644-5573
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-11-20
Last Update Date:2023-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)