Provider Demographics
NPI:1104298348
Name:ALCOHOL BEHAVIOR INFORMATION,INC.
Entity type:Organization
Organization Name:ALCOHOL BEHAVIOR INFORMATION,INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:JASMINE
Authorized Official - Middle Name:
Authorized Official - Last Name:VAGHEDI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:303-368-8702
Mailing Address - Street 1:1602 S PARKER RD
Mailing Address - Street 2:#110
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80231-2919
Mailing Address - Country:US
Mailing Address - Phone:303-368-8702
Mailing Address - Fax:
Practice Address - Street 1:1602 S PARKER RD
Practice Address - Street 2:#110
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80231-2919
Practice Address - Country:US
Practice Address - Phone:303-368-8702
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-27
Last Update Date:2017-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1799-01251S00000X
CO1799-00251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health