| Heart Of Boardwalk | |
|
709 E 12th Ave Denver CO 80203-2610 | |
| (303) 830-8805 | |
| (303) 830-8918 |
| Full Name | Heart Of Boardwalk |
|---|---|
| Speciality | Clinic/Center |
| Location | 709 E 12th Ave, Denver, Colorado |
| Authorized Official Name and Position | David Burgess (EXECUTIVE DIRECTOR) |
| Authorized Official Contact | 3038308805 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Heart Of Boardwalk 709 E 12th Ave Denver CO 80203-2610 Ph: (303) 830-8805 | Heart Of Boardwalk 709 E 12th Ave Denver CO 80203-2610 Ph: (303) 830-8805 |
| NPI Number | 1134129034 |
|---|---|
| Provider Enumeration Date | 07/21/2005 |
| Last Update Date | 12/26/2013 |
| Medicare PECOS PAC ID | 4789575614 |
|---|---|
| Medicare Enrollment ID | O20040322000950 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1134129034 | NPI | - | NPPES |
| 04008637 | Medicaid | CO |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0850X | Clinic/center - Adult Mental Health | 150402 (Colorado) | Primary |
| Provider Name | Jed Sickles Shapiro |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1396765558 PECOS PAC ID: 2062445133 Enrollment ID: I20050919000357 |
| Provider Name | Stephanie L Frank |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1144419581 PECOS PAC ID: 3476643198 Enrollment ID: I20071219000241 |
| Provider Name | Angela Marie Edstrom Kaushik |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1225554181 PECOS PAC ID: 7911332374 Enrollment ID: I20200114001345 |
| Provider Name | Jennifer L Jost |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1427711647 PECOS PAC ID: 7113399965 Enrollment ID: I20230206000028 |
| Provider Name | Isabella Kotnour |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1629522149 PECOS PAC ID: 9436680048 Enrollment ID: I20241108003041 |
| Provider Name | Jeff Citro |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1568716918 PECOS PAC ID: 0345779054 Enrollment ID: I20250124002805 |
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