Provider Demographics
NPI:1780092056
Name:COMMUNITY RE-ENTRY PLACE INSIDE/OUT
Entity type:Organization
Organization Name:COMMUNITY RE-ENTRY PLACE INSIDE/OUT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FOUNDER, EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:DEBORAH
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:WINANS
Authorized Official - Suffix:
Authorized Official - Credentials:CHAPLAIN BA, CACIII
Authorized Official - Phone:720-207-5041
Mailing Address - Street 1:14221 E 4TH AVE STE 330
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80011-8727
Mailing Address - Country:US
Mailing Address - Phone:720-207-5041
Mailing Address - Fax:
Practice Address - Street 1:14221 E 4TH AVE STE 330
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80011-8727
Practice Address - Country:US
Practice Address - Phone:720-207-5041
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-30
Last Update Date:2014-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1720-01305R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305R00000XManaged Care OrganizationsPreferred Provider Organization