Provider Demographics
NPI:1124623210
Name:REGENTS OF THE UNIVERSITY OF COLORADO
Entity type:Organization
Organization Name:REGENTS OF THE UNIVERSITY OF COLORADO
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ARTS DIRECTOR OF OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:ANGI
Authorized Official - Middle Name:
Authorized Official - Last Name:WOLD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:303-734-3317
Mailing Address - Street 1:3738 W PRINCETON CIR
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80236-3110
Mailing Address - Country:US
Mailing Address - Phone:303-761-6703
Mailing Address - Fax:
Practice Address - Street 1:3844 W PRINCETON CIR
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80236-3111
Practice Address - Country:US
Practice Address - Phone:303-761-6703
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:REGENTS OF THE UNIVERSITY OF COLORADO
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-12-04
Last Update Date:2021-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder
No324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO9000165416Medicaid