Provider Demographics
NPI:1316529068
Name:EDC OF DENVER, LLC
Entity type:Organization
Organization Name:EDC OF DENVER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE ASSISTANT
Authorized Official - Prefix:
Authorized Official - First Name:DAWN
Authorized Official - Middle Name:LYNNE
Authorized Official - Last Name:SULLIVAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:720-889-4227
Mailing Address - Street 1:11218 JOHN GALT BLVD STE 204
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68137-2358
Mailing Address - Country:US
Mailing Address - Phone:402-408-0294
Mailing Address - Fax:
Practice Address - Street 1:11218 JOHN GALT BLVD STE 204
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68137-2358
Practice Address - Country:US
Practice Address - Phone:402-408-0294
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-04-22
Last Update Date:2021-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes283Q00000XHospitalsPsychiatric Hospital