Provider Demographics
NPI:1992301550
Name:ALDER GROVE HEALTH SERVICES, INC
Entity type:Organization
Organization Name:ALDER GROVE HEALTH SERVICES, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:HOLLY
Authorized Official - Middle Name:
Authorized Official - Last Name:VAUSE
Authorized Official - Suffix:
Authorized Official - Credentials:PMHNP
Authorized Official - Phone:720-331-6899
Mailing Address - Street 1:90 MADISON ST STE 302
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80206-5412
Mailing Address - Country:US
Mailing Address - Phone:720-331-6899
Mailing Address - Fax:720-306-5499
Practice Address - Street 1:10465 MELODY DR STE 226
Practice Address - Street 2:
Practice Address - City:NORTHGLENN
Practice Address - State:CO
Practice Address - Zip Code:80234-4120
Practice Address - Country:US
Practice Address - Phone:720-331-6899
Practice Address - Fax:720-306-5499
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-12-09
Last Update Date:2020-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty