NPIMap

Organization Active NPI

Boulder Integrated Health LLC

  • Substance Abuse Rehabilitation Facility
  • Boulder, CO
National Provider Identifier
1376093898
Registry record updated Sep 10, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Substance Abuse Rehabilitation FacilityTaxonomy code 324500000X
Legal business name
BOULDER INTEGRATED HEALTH LLC
Practice address
2429 Broadway St
Boulder, CO 80304-4108
Phone
(720) 739-6500
Fax
(720) 204-3930
NPI assigned
Oct 7, 2016
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 10, 2021

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

Authorized official

Name
Mary Wilson
Title
Business Office Manager
Phone
(720) 739-6500

Specialties & licenses 1

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

Addresses

Primary practice location

2429 Broadway St
Boulder, CO 80304-4108

Mailing address

2429 Broadway St
Boulder, CO 80304-4108
Phone (720) 739-6500

Other names 1

  • Bolder Life Doing business as

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
06D2134210Boulder Integrated Health2429 Broadway, Boulder, CO 80304Certificate of waiverJul 26, 2027

National Provider Directory

National Provider Directory

Locations

2429 Broadway St
Boulder, CO 80304
Phone (720) 739-6500

Practitioners & affiliated clinicians

Practitioners 9

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": "1475798400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1631232000000",
    "number": "1376093898",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2429 BROADWAY ST",
            "city": "BOULDER",
            "state": "CO",
            "postal_code": "803044108",
            "telephone_number": "720-739-6500",
            "fax_number": "720-204-3930"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2429 BROADWAY ST",
            "city": "BOULDER",
            "state": "CO",
            "postal_code": "803044108",
            "telephone_number": "720-739-6500",
            "fax_number": "720-204-3930"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BOULDER INTEGRATED HEALTH LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-10-07",
        "last_updated": "2021-09-10",
        "certification_date": "2021-07-15",
        "status": "A",
        "authorized_official_last_name": "WILSON",
        "authorized_official_first_name": "MARY",
        "authorized_official_title_or_position": "BUSINESS OFFICE MANAGER",
        "authorized_official_telephone_number": "720-739-6500"
    },
    "taxonomies": [
        {
            "code": "324500000X",
            "taxonomy_group": "",
            "desc": "Substance Abuse Rehabilitation Facility",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Bolder Life",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Boulder, CO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 10, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.