Provider Demographics
NPI:1780160564
Name:ADDICTION RECOVERY CENTERS, LLC
Entity type:Organization
Organization Name:ADDICTION RECOVERY CENTERS, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:NATHANIEL
Authorized Official - Middle Name:J
Authorized Official - Last Name:MOORE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:720-878-7055
Mailing Address - Street 1:15101 E ILIFF AVE STE 250
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80014-4552
Mailing Address - Country:US
Mailing Address - Phone:720-878-7055
Mailing Address - Fax:720-390-5188
Practice Address - Street 1:15101 E ILIFF AVE STE 140
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80014-4548
Practice Address - Country:US
Practice Address - Phone:720-878-7055
Practice Address - Fax:720-390-5188
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-07-16
Last Update Date:2018-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COCDRH.0035543207QA0401X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QA0401XAllopathic & Osteopathic PhysiciansFamily MedicineAddiction MedicineGroup - Single Specialty