RECOVERY VILLAGE AT PALMER LAKE, LLC (NPI# 1356738132) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1356738132 |
| Entity Type | Organization |
| Organization Name | RECOVERY VILLAGE AT PALMER LAKE, LLC |
| Practice Address |
443 Highway 105 Palmer Lake CO 80133-9003 |
| Mailing Address |
100 Se Third Ave, Suite 1800 Fort Lauderdale FL 33394 |
| Practice Telephone | 7194811800 |
| Mailing Telephone | 7543003120 |
| Mailing Fax Number | 8889194431 |
| Enumeration Date | 2015-04-20 |
| Last Update Date | 2019-06-17 |
| Authorized Official Name | BELINA SURUJON (LICENSING & CONTRACTING DIRECTOR) |
| Authorized Official Telephone | 7543003120 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 324500000X | Substance Abuse Rehabilitation Facility | Residential Treatment Facilities |
| Entity Type | Entity Name | Entity Address |
|---|---|---|
| Colorado Business Entities | Recovery Village at Palmer Lake, LLC | 100 Se 3rd Ave Ste 1800, Fort Lauderdale, FL 33394 |
| Street Address |
443 HIGHWAY 105 |
| City | PALMER LAKE |
| State | CO |
| Zip Code | 80133-9003 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1790984623 | Robert John Ochsner | Family Medicine | 443 Highway 105, Palmer Lake, CO 80133-9003 | 2007-07-11 |
| 1255821831 | Amanda Harms | Counselor | 443 Highway 105, Palmer Lake, CO 80133-9003 | 2018-05-18 |
| 1760998892 | Cynthia White | Counselor | 443 Highway 105, Palmer Lake, CO 80133-9003 | 2017-12-27 |
| 1578079125 | Kristin L Malone | Counselor | 443 Highway 105, Palmer Lake, CO 80133-9003 | 2017-12-19 |
| 1902316375 | Kynzi Roberts | Counselor | 443 Highway 105, Palmer Lake, CO 80133-9003 | 2017-10-11 |
| 1194234021 | Renae Chalaine Helms | Counselor | 443 Highway 105, Palmer Lake, CO 80133 | 2017-09-22 |
| 1710406129 | Jennifer Pipes-torgerson | Counselor | 443 Highway 105, Palmer Lake, CO 80133-9003 | 2017-09-18 |
| 1710406020 | Kristina Williams | Counselor | 443 Highway 105, Palmer Lake, CO 80133-9003 | 2017-09-18 |
| 1164872149 | Michelle Roberts | Counselor | 443 Highway 105, Palmer Lake, CO 80133-9003 | 2016-06-21 |
| 1306265319 | Cristyn Smith | Counselor | 443 Highway 105, Palmer Lake, CO 80133-9003 | 2014-04-08 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1194357525 | Elizabeth Nicole English | Counselor | 443 S County Road 105, Palmer Lake, CO 80133 | 2020-02-04 |
| 1457990210 | David Allen Garcia | Counselor | 443 S. Colorado 105, Palmer Lake, CO 80133 | 2019-12-27 |
| 1952878407 | Eric Alan Burton | Counselor | 7 Suncrest Rd, Palmer Lake, CO 80133 | 2018-11-01 |
| 1457864340 | Leesa Worley | Respite Care | 363 Suncrest Rd, Palmer Lake, CO 80133 | 2017-11-14 |
| 1629595541 | Mary Illona Burford | Respite Care | 213 Park St, Palmer Lake, CO 80133 | 2017-08-23 |
| 1326594920 | Melissa Wooters | Contractor | 444 Virginia Ave, Palmer Lake, CO 80133 | 2016-09-01 |
| 1568816312 | Diana Barfoot | Social Worker | 443 S Co-105, Palmer Lake, CO 80133 | 2016-04-19 |
| 1811366974 | Katelyn Marsh | Counselor | 443 S Co-105, Palmer Lake, CO 80133 | 2015-09-18 |
| 1952510612 | Heather Lee Simpson | Massage Therapist | 151 Epworth Hwy, Palmer Lake, CO 80133 | 2007-05-21 |
| 1043841877 | Anthony Rodenbaugh | Counselor | 443 S Co-105, Palmer Lake, CO 80133 | 2020-01-30 |
| Find all providers in zip 80133 | ||||
| Taxonomy Code | 324500000X |
| Grouping | Residential Treatment Facilities |
| Classification | Substance Abuse Rehabilitation Facility |
| A facility or distinct part of a facility that provides a 24 hr therapeutically planned living and rehabilitative intervention environment for the treatment of individuals with disorders in the abuse of drugs, alcohol, and other substances. |
| Notes: [7/1/2003: modified title, modified definition] |
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| 1710591573 | Lotus Lodge Men, LLC | Substance Abuse Rehabilitation Facility | 16313 E 7th Dr, Aurora, CO 80011-4524 | 2020-08-31 |
| 1710509583 | Crossroads' Turning Points, Inc. | Substance Abuse Rehabilitation Facility | 1004 Carbon Place, Trinidad, CO 81082 | 2020-05-14 |
| 1538796156 | Rocky Mountain Detox, LLC | Substance Abuse Rehabilitation Facility | 1336 Pierce St, Lakewood, CO 80214-1939 | 2020-03-24 |
| 1215574413 | Healing Pines Recovery, LLC. | Substance Abuse Rehabilitation Facility | 5550 County Road 124, Elizabeth, CO 80107 | 2019-12-06 |
| 1790328607 | Gallus Detox Denver LLC | Substance Abuse Rehabilitation Facility | 5920 S Estes St Ste 150, Littleton, CO 80123-8620 | 2019-10-23 |
| 1114584232 | Scw Recovery LLC | Substance Abuse Rehabilitation Facility | 330 Fiedler Ave, Ste 103, Dillon, CO 80435 | 2019-05-23 |
| 1902462617 | Colorado West Regional Mental Health, Inc. | Substance Abuse Rehabilitation Facility | 2800 Riverside Pkwy Bldg 2, Grand Junction, CO 81501-4721 | 2019-05-17 |
| 1487122057 | Valiant Dtx, LLC | Substance Abuse Rehabilitation Facility | 2602 S Ensenada Way, Aurora, CO 80013-7690 | 2018-11-12 |
| Find all providers with the same taxonomy | ||||
| City | PALMER LAKE |
| Zip Code | 80133 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.