Provider Demographics
NPI:1104653658
Name:RADICAL HEALING LLC
Entity type:Organization
Organization Name:RADICAL HEALING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BERNADETTE
Authorized Official - Middle Name:
Authorized Official - Last Name:PIVARUNAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:970-236-6317
Mailing Address - Street 1:2001 S SHIELDS ST STE 203
Mailing Address - Street 2:
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80526-1827
Mailing Address - Country:US
Mailing Address - Phone:970-236-6317
Mailing Address - Fax:
Practice Address - Street 1:90 MADISON ST STE 700
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80206-5416
Practice Address - Country:US
Practice Address - Phone:970-236-6317
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-09-18
Last Update Date:2024-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty