Provider Demographics
NPI:1407390586
Name:DEPARTMENT OF JUSTICE
Entity type:Organization
Organization Name:DEPARTMENT OF JUSTICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:SANTINI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:303-763-4300
Mailing Address - Street 1:1275 CAPRICORN CT
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80905-7175
Mailing Address - Country:US
Mailing Address - Phone:719-475-7539
Mailing Address - Fax:
Practice Address - Street 1:9595 W QUINCY AVE
Practice Address - Street 2:
Practice Address - City:LITTLETON
Practice Address - State:CO
Practice Address - Zip Code:80123-1159
Practice Address - Country:US
Practice Address - Phone:303-763-4300
Practice Address - Fax:303-980-2332
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-12-08
Last Update Date:2016-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA88608261QP2400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2400XAmbulatory Health Care FacilitiesClinic/CenterPrison Health