Provider Demographics
NPI:1528455797
Name:EDC OF DENVER, LLC
Entity type:Organization
Organization Name:EDC OF DENVER, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE ASSISITANT
Authorized Official - Prefix:
Authorized Official - First Name:DAWN
Authorized Official - Middle Name:
Authorized Official - Last Name:SULLIVAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:720-889-4227
Mailing Address - Street 1:8500 SHAWNEE MISSION PKWY
Mailing Address - Street 2:SUITE L-1
Mailing Address - City:MERRIAM
Mailing Address - State:KS
Mailing Address - Zip Code:66202-2967
Mailing Address - Country:US
Mailing Address - Phone:913-945-1277
Mailing Address - Fax:
Practice Address - Street 1:8500 SHAWNEE MISSION PKWY
Practice Address - Street 2:SUITE L-1
Practice Address - City:MERRIAM
Practice Address - State:KS
Practice Address - Zip Code:66202-2967
Practice Address - Country:US
Practice Address - Phone:913-945-1277
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:EDC OF DENVER, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-04-24
Last Update Date:2015-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty