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Organization
PROVIDENCE NETWORK
Active
Organization
PROVIDENCE NETWORK
Active
Other names
The Executive Network
Organization subpart
No
Provider details
NPI number
Authorized official
DEREK KUYKENDALL (EXECUTIVE DIRECTOR)
(303) 860-8484
Entity
Organization
Contact information
Practice address
357 N BROADWAY, DENVER, CO 80203-3920
(303) 860-8404
Mailing address
357 N BROADWAY, DENVER, CO 80203-3920
(303) 860-8404
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
—
NULL
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
—
—
177F00000X
Lodging Provider
—
NULL
251B00000X
Case Management Agency
—
NULL
251S00000X
Community/Behavioral Health Agency
—
NULL
Other
Enumeration date
03/07/2024
Last updated
03/07/2024
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