Provider Demographics
NPI:1093556417
Name:THE FOUNDRY STEAMBOAT LLC
Entity type:Organization
Organization Name:THE FOUNDRY STEAMBOAT LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:
Authorized Official - Last Name:WALKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:571-237-2697
Mailing Address - Street 1:11952 GRAY ST
Mailing Address - Street 2:
Mailing Address - City:WESTMINSTER
Mailing Address - State:CO
Mailing Address - Zip Code:80020-5906
Mailing Address - Country:US
Mailing Address - Phone:844-955-1066
Mailing Address - Fax:
Practice Address - Street 1:11952 GRAY ST
Practice Address - Street 2:
Practice Address - City:WESTMINSTER
Practice Address - State:CO
Practice Address - Zip Code:80020-5906
Practice Address - Country:US
Practice Address - Phone:844-955-1066
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:THE FOURNDRY STEAMBOAT LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2024-06-03
Last Update Date:2024-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility