Provider Demographics
NPI:1386910057
Name:PRONERVE READ CENTER
Entity type:Organization
Organization Name:PRONERVE READ CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:GREG
Authorized Official - Middle Name:
Authorized Official - Last Name:PASCHKE
Authorized Official - Suffix:
Authorized Official - Credentials:CFO
Authorized Official - Phone:720-536-2380
Mailing Address - Street 1:350 INTERLOCKEN BLVD
Mailing Address - Street 2:SUITE 360
Mailing Address - City:BROOMFIELD
Mailing Address - State:CO
Mailing Address - Zip Code:80021-8006
Mailing Address - Country:US
Mailing Address - Phone:720-407-2700
Mailing Address - Fax:303-339-1498
Practice Address - Street 1:3030 NORTH CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:PHOENI
Practice Address - State:AZ
Practice Address - Zip Code:85012
Practice Address - Country:US
Practice Address - Phone:720-407-2700
Practice Address - Fax:303-339-1498
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-28
Last Update Date:2012-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty