Basic Information
Provider Information
NPI: 1003403833
EntityType: 2
ReplacementNPI:  
OrganizationName: AURORA COMPREHENSIVE COMMUNITY MENTAL HEALTH CENTER, INC
LastName:  
FirstName:  
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential:  
OtherOrganizationName: AURORA MENTAL HEALTH CENTER
OtherOrganizationType: 3
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 1290 CHAMBERS RD
Address2:  
City: AURORA
State: CO
PostalCode: 800117117
CountryCode: US
TelephoneNumber: 3036172300
FaxNumber:  
Practice Location
Address1: 10782 E ALAMEDA AVE
Address2:  
City: AURORA
State: CO
PostalCode: 800121017
CountryCode: US
TelephoneNumber: 3036172300
FaxNumber:  
Other Information
ProviderEnumerationDate: 12/28/2020
LastUpdateDate: 12/29/2020
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode:  
AuthorizedOfficialLastName: GRACE
AuthorizedOfficialFirstName: DEBRA
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition: CREDENTIALING SPECIALIST
AuthorizedOfficialTelephone: 3036172300
IsSoleProprietor:  
IsOrganizationSubpart: N
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 12/29/2020

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
261QM0801X  N Ambulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
261QR0405X  Y Ambulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder

No ID Information.


Home