Provider Demographics
NPI:1871976928
Name:STATE OF COLORADO DEPARTMENT OF HUMAN SERVICES
Entity type:Organization
Organization Name:STATE OF COLORADO DEPARTMENT OF HUMAN SERVICES
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:AGENCY DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:CHRISTIAN
Authorized Official - Last Name:MUELLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:970-255-5711
Mailing Address - Street 1:2800 RIVERSIDE PKWY
Mailing Address - Street 2:
Mailing Address - City:GRAND JUNCTION
Mailing Address - State:CO
Mailing Address - Zip Code:81501-4721
Mailing Address - Country:US
Mailing Address - Phone:970-255-5711
Mailing Address - Fax:970-255-5714
Practice Address - Street 1:2800 RIVERSIDE PKWY
Practice Address - Street 2:
Practice Address - City:GRAND JUNCTION
Practice Address - State:CO
Practice Address - Zip Code:81501-4721
Practice Address - Country:US
Practice Address - Phone:970-255-5711
Practice Address - Fax:970-255-5714
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-08
Last Update Date:2015-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO8513261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental