Provider Demographics
NPI:1811159551
Name:INNER CITY HEALTH CENTER
Entity type:Organization
Organization Name:INNER CITY HEALTH CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPERATIONS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KARINA
Authorized Official - Middle Name:
Authorized Official - Last Name:VILLAGRANA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:720-833-5068
Mailing Address - Street 1:3800 YORK ST
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80205-3972
Mailing Address - Country:US
Mailing Address - Phone:303-296-4873
Mailing Address - Fax:303-382-2808
Practice Address - Street 1:3800 YORK ST
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80205-3972
Practice Address - Country:US
Practice Address - Phone:303-296-4873
Practice Address - Fax:303-382-2808
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-25
Last Update Date:2023-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
122300000X, 261QF0400X
CO122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
No122300000XDental ProvidersDentistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO04004552Medicaid
CO9000172845Medicaid
CO9000178587Medicaid