Provider Demographics
NPI:1194049478
Name:CHILDRENS VILLAGE OF HOPE
Entity type:Organization
Organization Name:CHILDRENS VILLAGE OF HOPE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:COREY
Authorized Official - Middle Name:A
Authorized Official - Last Name:CANDELARIA
Authorized Official - Suffix:
Authorized Official - Credentials:MA, LPC
Authorized Official - Phone:720-887-4036
Mailing Address - Street 1:2010 W 120TH AVE
Mailing Address - Street 2:#105
Mailing Address - City:WESTMINSTER
Mailing Address - State:CO
Mailing Address - Zip Code:80234-2444
Mailing Address - Country:US
Mailing Address - Phone:720-887-4036
Mailing Address - Fax:
Practice Address - Street 1:5105 PASADENA WAY
Practice Address - Street 2:
Practice Address - City:BROOMFIELD
Practice Address - State:CO
Practice Address - Zip Code:80023-4029
Practice Address - Country:US
Practice Address - Phone:720-887-4036
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-16
Last Update Date:2010-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty