Organization
METRO COMMUNITY PROVIDER NETWORK, INC.
Active
Parent organization
METRO COMMUNITY PROVIDER NETWORK, INC.
Other names
Independence Health Center at Jefferson Center for Mental Health, STRIDE CHC - Independence at Jefferson Center
Organization subpart
Yes
Provider details
NPI number
Legal business name
METRO COMMUNITY PROVIDER NETWORK, INC.
Authorized official
MR. BEN R. WIEDERHOLT (PRESIDENT AND CEO)
(303) 761-1977
Entity
Organization
Contact information
Practice address
4851 INDEPENDENCE STREET, WHEAT RIDGE, CO 80033-6715
(303) 274-7094
(303) 274-7095
Mailing address
2255 S ONEIDA ST, DENVER, CO 80224-2522
(303) 761-1977
(303) 761-2787
Taxonomy
Speciality
Code
Description
License number
State
261QF0400X
Federally Qualified Health Center (FQHC)
Primary
—
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
58038230
—
CO
Enumeration date
06/21/2011
Last updated
03/10/2020
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