Provider Demographics
NPI:1902275936
Name:CENTURA VENTURES, LLC
Entity Type:Organization
Organization Name:CENTURA VENTURES, LLC
Other - Org Name:CHPG PHYSICAL MEDICINE CHURCH RANCH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:SUE
Authorized Official - Middle Name:
Authorized Official - Last Name:JARDON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:719-571-8899
Mailing Address - Street 1:PO BOX 912425
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80291-2425
Mailing Address - Country:US
Mailing Address - Phone:719-562-6303
Mailing Address - Fax:303-397-2103
Practice Address - Street 1:7233 CHURCH RANCH BLVD
Practice Address - Street 2:JUNIPER POD
Practice Address - City:WESTMINSTER
Practice Address - State:CO
Practice Address - Zip Code:80021-4094
Practice Address - Country:US
Practice Address - Phone:303-925-4003
Practice Address - Fax:303-925-4024
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-09-21
Last Update Date:2015-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
COCOB4569Medicare PIN