NPIMap

Organization Active NPI

Island Grove Regional Treatment Center

  • Substance Abuse Rehabilitation Facility
  • Greeley, CO
National Provider Identifier
1952589327
Registry record updated Feb 7, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Substance Abuse Rehabilitation FacilityTaxonomy code 324500000X
License
105109 Issued in CO
Legal business name
ISLAND GROVE REGIONAL TREATMENT CENTER
Practice address
1260 H Street
Greeley, CO 80631
Phone
(970) 351-6678
Fax
(970) 352-7457
NPI assigned
Feb 7, 2008
Last updated
Feb 7, 2008By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 7, 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 105109 CO Primary

Addresses

Primary practice location

1260 H Street
Greeley, CO 80631

Mailing address

1260 H Street
Greeley, CO 80631
Phone (970) 351-6678

Other identifiers 1

IdentifierTypeStateIssuer
04055764MedicaidCO

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

1260 H St
Greeley, CO 80631
Phone (970) 313-1091

NPI Registry JSON

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

{
    "created_epoch": "1202342400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1202342400000",
    "number": "1952589327",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1260 H STREET",
            "city": "GREELEY",
            "state": "CO",
            "postal_code": "80631",
            "telephone_number": "970-351-6678",
            "fax_number": "970-352-7457"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1260 H STREET",
            "city": "GREELEY",
            "state": "CO",
            "postal_code": "80631",
            "telephone_number": "970-351-6678",
            "fax_number": "970-352-7457"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ISLAND GROVE REGIONAL TREATMENT CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-02-07",
        "last_updated": "2008-02-07",
        "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": "105109",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "04055764",
            "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 Feb 7, 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.