NPIMap

Organization Active NPI

Jefferson Center for Mental Health

  • Substance Use Disorder Rehabilitation Clinic/Center
  • Idaho Springs, CO
National Provider Identifier
1740586189
Registry record updated Dec 15, 2021
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
1969 Miner Street
Idaho Springs, CO 80452
Phone
(303) 425-0300
Fax
(303) 567-3132
NPI assigned
Feb 2, 2011
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 15, 2021

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

1969 Miner Street
Idaho Springs, CO 80452

Mailing address

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

Other identifiers 1

IdentifierTypeStateIssuer
9000163761MedicaidCO

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 24

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

View all 24

Locations

15193 Highway 119
Black Hawk, CO 80422

Practitioners & affiliated clinicians

Practitioners 4

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": "1639526400000",
    "number": "1740586189",
    "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": "1969 MINER STREET",
            "city": "IDAHO SPRINGS",
            "state": "CO",
            "postal_code": "80452",
            "telephone_number": "303-425-0300",
            "fax_number": "303-567-3132"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JEFFERSON CENTER FOR MENTAL HEALTH",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-02-02",
        "last_updated": "2021-12-15",
        "certification_date": "2021-12-14",
        "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": "9000163761",
            "state": "CO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Idaho Springs, CO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 15, 2021; 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.