NPIMap

Organization Active NPI

Island Grove Regional Treatment Center

  • Substance Abuse Rehabilitation Facility
  • Ft Collins, CO
National Provider Identifier
1194903153
Registry record updated Feb 1, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Substance Abuse Rehabilitation FacilityTaxonomy code 324500000X
License
105104 Issued in CO
Legal business name
ISLAND GROVE REGIONAL TREATMENT CENTER
Practice address
212 W Mountain Avenue
Ft Collins, CO 80521
Phone
(970) 493-1157
Fax
(970) 224-9606
NPI assigned
Feb 1, 2008
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 1, 2008

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

Authorized official

Name
Mr. Kendall P Alexander, MSW
Title
Executive Director
Phone
(970) 356-6664

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Substance Abuse Rehabilitation Facility 324500000X 105104 CO Primary

Addresses

Primary practice location

212 W Mountain Avenue
Ft Collins, CO 80521

Mailing address

212 W Mountain Avenue
Ft Collins, CO 80521
Phone (970) 493-1157

Other identifiers 1

IdentifierTypeStateIssuer
75753766MedicaidCO

National Provider Directory

National Provider Directory
Tax ID family
Island Grove Regional Treatment Center4 organizations share this tax ID, including this one

Other organizations with this tax ID 3

Organizations that report the same tax identification number in the National Provider Directory.

Locations

212 W Mountain Ave
Fort Collins, CO 80521
Phone (970) 493-1157

NPI Registry JSON

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

{
    "created_epoch": "1201824000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1201824000000",
    "number": "1194903153",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "212 W MOUNTAIN AVENUE",
            "city": "FT COLLINS",
            "state": "CO",
            "postal_code": "80521",
            "telephone_number": "970-493-1157",
            "fax_number": "970-224-9606"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "212 W MOUNTAIN AVENUE",
            "city": "FT COLLINS",
            "state": "CO",
            "postal_code": "80521",
            "telephone_number": "970-493-1157",
            "fax_number": "970-224-9606"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ISLAND GROVE REGIONAL TREATMENT CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-02-01",
        "last_updated": "2008-02-01",
        "status": "A",
        "authorized_official_last_name": "ALEXANDER",
        "authorized_official_first_name": "KENDALL",
        "authorized_official_middle_name": "P",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "970-356-6664",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "MSW"
    },
    "taxonomies": [
        {
            "code": "324500000X",
            "taxonomy_group": "",
            "desc": "Substance Abuse Rehabilitation Facility",
            "state": "CO",
            "license": "105104",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "75753766",
            "state": "CO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Ft Collins, CO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 1, 2008; 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.