Provider Demographics
NPI:1548924798
Name:THIRD WAY CENTER, INC
Entity type:Organization
Organization Name:THIRD WAY CENTER, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DATA OPERATIONS COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:ERIN
Authorized Official - Middle Name:
Authorized Official - Last Name:MARTIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:303-780-9191
Mailing Address - Street 1:PO BOX 61385
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80206-8385
Mailing Address - Country:US
Mailing Address - Phone:303-780-9191
Mailing Address - Fax:
Practice Address - Street 1:1133 N LINCOLN ST
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80203-2110
Practice Address - Country:US
Practice Address - Phone:303-832-6622
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-10-25
Last Update Date:2021-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes322D00000XResidential Treatment FacilitiesResidential Treatment Facility, Emotionally Disturbed Children
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO08437335Medicaid