# COLORADO DEPARTMENT OF CORRECTIONS

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- **Entity:** Organization
- **Status:** Active
- **Parent organization:** STATE OF COLORADO
- **Other names:** Centennial Correctional Facility
- **Organization subpart:** Yes

## Provider details

- **NPI number:** 1780574715
- **Legal business name:** STATE OF COLORADO
- **Authorized official:** DR. RANDOLPH MAUL MD (CHIEF MEDICAL OFFICER)
- **Authorized official phone:** (719) 306-2821

## Contact information

- **Practice address:** HIGHWAY 50 EAST & EVANS BLVD, CANON CITY, CO 81212
- **Practice address phone:** (719) 269-4812
- **Practice address fax:** (719) 269-5847
- **Mailing address:** PO BOX 600, CCF MEDICAL, CANON CITY, CO 81215
- **Mailing address phone:** (719) 269-4812
- **Mailing address fax:** (719) 269-5847

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QP2400X | Prison Health Clinic/Center | — | NULL | Yes |

## Other

- **Enumeration date:** 07/09/2025
- **Last updated:** 07/14/2025