Provider Demographics
NPI:1639925167
Name:RENEWED HOPE TRIBAL HEALTH AUTHORITY
Entity type:Organization
Organization Name:RENEWED HOPE TRIBAL HEALTH AUTHORITY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:LOUIS
Authorized Official - Last Name:KERSHNER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:303-859-2742
Mailing Address - Street 1:6650 GUNPARK DR STE 100
Mailing Address - Street 2:
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80301-7003
Mailing Address - Country:US
Mailing Address - Phone:303-468-0020
Mailing Address - Fax:303-568-7753
Practice Address - Street 1:690 DE LONG AVE
Practice Address - Street 2:
Practice Address - City:NOVATO
Practice Address - State:CA
Practice Address - Zip Code:94945-3359
Practice Address - Country:US
Practice Address - Phone:707-463-1454
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-04-25
Last Update Date:2024-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder