Provider Demographics
NPI:1215304605
Name:ELK FAMILY RECOVERY
Entity type:Organization
Organization Name:ELK FAMILY RECOVERY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PROGRAM DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:BRAD
Authorized Official - Middle Name:
Authorized Official - Last Name:OSBORN
Authorized Official - Suffix:
Authorized Official - Credentials:CACIII, CAI
Authorized Official - Phone:970-927-0556
Mailing Address - Street 1:400 ALEXANDER LN
Mailing Address - Street 2:
Mailing Address - City:BASALT
Mailing Address - State:CO
Mailing Address - Zip Code:81621-8117
Mailing Address - Country:US
Mailing Address - Phone:970-927-0556
Mailing Address - Fax:
Practice Address - Street 1:400 ALEXANDER LN
Practice Address - Street 2:
Practice Address - City:BASALT
Practice Address - State:CO
Practice Address - Zip Code:81621-8117
Practice Address - Country:US
Practice Address - Phone:970-927-0556
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:TRADITIONS TREATMENT NETWORK
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-09-01
Last Update Date:2016-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health