NPIMap

Organization Active NPI

Jefferson Center for Mental Health

  • Substance Use Disorder Rehabilitation Clinic/Center
  • Evergreen, CO
National Provider Identifier
1154627503
Registry record updated Dec 4, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Substance Use Disorder Rehabilitation Clinic/CenterTaxonomy code 261QR0405X
Legal business name
JEFFERSON CENTER FOR MENTAL HEALTH
Practice address
31207 Keats Way Ste 202
Evergreen, CO 80439-2220
Phone
(303) 432-5300
Fax
(303) 432-5350
NPI assigned
Feb 2, 2011
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 4, 2020

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mr. David A Goff
Title
Chief Financial Officer
Phone
(303) 432-5164

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Addiction (Substance Use Disorder) CounselorGroup: 193200000X MULTI-SPECIALTY GROUP 101YA0400X 150413 CO
Substance Use Disorder Rehabilitation Clinic/Center 261QR0405X Primary

Addresses

Primary practice location

31207 Keats Way Ste 202
Evergreen, CO 80439-2220

Mailing address

4851 Independence St Ste 200
Wheat Ridge, CO 80033-6712
Phone (303) 425-0300

Other identifiers 1

IdentifierTypeStateIssuer
9000163981MedicaidCO

National Provider Directory

National Provider Directory
Tax ID family
Jefferson Ctr Mental Health57 organizations share this tax ID, including this one

Organizations with this tax ID in the same state 18

This tax ID family is large, so up to 24 of its organizations in the same state are linked here.

View all 18

Locations

10595 Highway 119
Black Hawk, CO 80422
Phone (303) 582-3444

Practitioners & affiliated clinicians

Practitioners 12

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1296604800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1607040000000",
    "number": "1154627503",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4851 INDEPENDENCE ST STE 200",
            "city": "WHEAT RIDGE",
            "state": "CO",
            "postal_code": "800336712",
            "telephone_number": "303-425-0300",
            "fax_number": "303-432-5071"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "31207 KEATS WAY STE 202",
            "city": "EVERGREEN",
            "state": "CO",
            "postal_code": "804392220",
            "telephone_number": "303-432-5300",
            "fax_number": "303-432-5350"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JEFFERSON CENTER FOR MENTAL HEALTH",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-02-02",
        "last_updated": "2020-12-04",
        "certification_date": "2020-10-27",
        "status": "A",
        "authorized_official_last_name": "GOFF",
        "authorized_official_first_name": "DAVID",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "CHIEF FINANCIAL OFFICER",
        "authorized_official_telephone_number": "303-432-5164",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "CO",
            "license": "150413",
            "primary": false
        },
        {
            "code": "261QR0405X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rehabilitation, Substance Use Disorder",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "9000163981",
            "state": "CO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Evergreen, CO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 4, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.