NPIMap

Organization Active NPI

North Range Behavioral Health

  • Substance Use Disorder Rehabilitation Clinic/Center
  • Greeley, CO
National Provider Identifier
1467068379
Registry record updated Sep 17, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Substance Use Disorder Rehabilitation Clinic/CenterTaxonomy code 261QR0405X
Legal business name
NORTH RANGE BEHAVIORAL HEALTH
Practice address
1306 11TH Ave
Greeley, CO 80631-3835
Phone
(970) 347-2120
NPI assigned
Sep 17, 2020
Last updated
Sep 17, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 17, 2020

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

Authorized official

Name
Larry Pottorff
Title
Executive Director
Phone
(970) 347-2373

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Substance Use Disorder Rehabilitation Clinic/Center 261QR0405X Primary

Addresses

Primary practice location

1306 11TH Ave
Greeley, CO 80631-3835

Mailing address

1300 N 17TH Ave
Greeley, CO 80631-9584
Phone (970) 347-2120

Other identifiers 1

IdentifierTypeStateIssuer
9000164585MedicaidCO

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CO

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040316000674 CO Part B Supplier - Clinic/Group Practice 1951299486 Receives reassigned benefits from 29 practitioners
32 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Greeley, CO; Windsor, CO; Frederick, CO; Fort Lupton, CO; Evans, CO

Other NPIs on the same Medicare enrollment 32

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

View all 32

National Provider Directory

National Provider Directory

Locations

1306 11th Ave
Greeley, CO 80631
Phone (970) 347-2125

NPI Registry JSON

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

{
    "created_epoch": "1600300800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1600300800000",
    "number": "1467068379",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1300 N 17TH AVE",
            "city": "GREELEY",
            "state": "CO",
            "postal_code": "806319584",
            "telephone_number": "970-347-2120"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1306 11TH AVE",
            "city": "GREELEY",
            "state": "CO",
            "postal_code": "806313835",
            "telephone_number": "970-347-2120"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NORTH RANGE BEHAVIORAL HEALTH",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-09-17",
        "last_updated": "2020-09-17",
        "certification_date": "2020-09-15",
        "status": "A",
        "authorized_official_last_name": "POTTORFF",
        "authorized_official_first_name": "LARRY",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "970-347-2373"
    },
    "taxonomies": [
        {
            "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": "9000164585",
            "state": "CO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Greeley, CO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 17, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.