Organization
METRO COMMUNITY PROVIDER NETWORK, INC.
Active
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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