NPIMap

Organization Active NPI

Providence Network

  • Addiction (Substance Use Disorder) Counselor
  • Denver, CO
National Provider Identifier
1285492942
Registry record updated Mar 7, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Addiction (Substance Use Disorder) CounselorTaxonomy code 101YA0400X
Legal business name
PROVIDENCE NETWORK
Practice address
357 N Broadway
Denver, CO 80203-3920
Phone
(303) 860-8404
NPI assigned
Mar 7, 2024
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 7, 2024

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

Authorized official

Name
Derek Kuykendall
Title
Executive Director
Phone
(303) 860-8484

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Addiction (Substance Use Disorder) CounselorGroup: 193200000X MULTI-SPECIALTY GROUP 101YA0400X Primary
Lodging Provider 177F00000X
Case Management Agency 251B00000X
Community/Behavioral Health Agency 251S00000X

Addresses

Primary practice location

357 N Broadway
Denver, CO 80203-3920

Mailing address

357 N Broadway
Denver, CO 80203-3920
Phone (303) 860-8404

Other practice location 1

801 N Logan St
Denver, CO 80203-3114
Phone (303) 860-8404

Other names 1

  • The Executive Network Former legal business name

National Provider Directory

National Provider Directory
Tax ID family
Providence Network6 organizations share this tax ID, including this one

Other organizations with this tax ID 5

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

Locations

801 N Logan St
Denver, CO 80203
Phone (303) 744-3986

357 N Broadway
Denver, CO 80203
Phone (303) 860-8404

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1709769600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1709769600000",
    "number": "1285492942",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "357 N BROADWAY",
            "city": "DENVER",
            "state": "CO",
            "postal_code": "802033920",
            "telephone_number": "303-860-8404"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "357 N BROADWAY",
            "city": "DENVER",
            "state": "CO",
            "postal_code": "802033920",
            "telephone_number": "303-860-8404"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "801 N Logan St",
            "address_purpose": "LOCATION",
            "city": "Denver",
            "state": "CO",
            "postal_code": "802033114",
            "country_code": "US",
            "telephone_number": "303-860-8404",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "PROVIDENCE NETWORK",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-03-07",
        "last_updated": "2024-03-07",
        "certification_date": "2024-03-07",
        "status": "A",
        "authorized_official_last_name": "KUYKENDALL",
        "authorized_official_first_name": "DEREK",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "303-860-8484"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "177F00000X",
            "taxonomy_group": "",
            "desc": "Lodging",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "251B00000X",
            "taxonomy_group": "",
            "desc": "Case Management",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "The Executive Network",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

Other providers in Denver, CO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 7, 2024; 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.