Organization
PROVIDENT SENIOR HEALTH, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
BILL NOONING (CEO)
(303) 493-5270
Entity
Organization
Contact information
Practice address
799 E HAMPDEN AVE, SUITE 300, ENGLEWOOD, CO 80113-2700
(303) 493-5270
(303) 493-5295
Mailing address
PO BOX 60, ENGLEWOOD, CO 80151-0060
(303) 493-5270
(303) 493-5295
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
25175025
—
CO
Enumeration date
04/25/2006
Last updated
08/19/2013
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