Provider Demographics
NPI:1780496059
Name:MEDICINE PARK MENTAL HEALTH
Entity type:Organization
Organization Name:MEDICINE PARK MENTAL HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CAROLINE
Authorized Official - Middle Name:
Authorized Official - Last Name:JOURNEYCAKE
Authorized Official - Suffix:
Authorized Official - Credentials:MS, APN, PMHNP
Authorized Official - Phone:720-237-3720
Mailing Address - Street 1:30238 CARRIAGE LOOP DR
Mailing Address - Street 2:
Mailing Address - City:EVERGREEN
Mailing Address - State:CO
Mailing Address - Zip Code:80439-8560
Mailing Address - Country:US
Mailing Address - Phone:720-237-3720
Mailing Address - Fax:
Practice Address - Street 1:2922 EVERGREEN PKWY STE 207
Practice Address - Street 2:
Practice Address - City:EVERGREEN
Practice Address - State:CO
Practice Address - Zip Code:80439-7915
Practice Address - Country:US
Practice Address - Phone:719-257-3709
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-01-23
Last Update Date:2025-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO90000230024Medicaid