Provider Demographics
NPI:1104244516
Name:PROJECT WORTHMORE
Entity type:Organization
Organization Name:PROJECT WORTHMORE
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PROGRAM MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CAROLYN
Authorized Official - Middle Name:
Authorized Official - Last Name:ANELLO
Authorized Official - Suffix:
Authorized Official - Credentials:RDH
Authorized Official - Phone:720-460-0995
Mailing Address - Street 1:1666 ELMIRA ST
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80010-2122
Mailing Address - Country:US
Mailing Address - Phone:720-460-0995
Mailing Address - Fax:
Practice Address - Street 1:1666 ELMIRA ST
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80010-2122
Practice Address - Country:US
Practice Address - Phone:720-460-0995
Practice Address - Fax:877-434-7701
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PROJECT WORTHMORE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-04-02
Last Update Date:2020-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO000905629251V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251V00000XAgenciesVoluntary or Charitable
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO83377310Medicaid