Provider Demographics
NPI:1487122057
Name:VALIANT DTX, LLC
Entity type:Organization
Organization Name:VALIANT DTX, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:DINNEEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:720-802-0497
Mailing Address - Street 1:5600 S QUEBEC ST STE 126B
Mailing Address - Street 2:
Mailing Address - City:GREENWOOD VILLAGE
Mailing Address - State:CO
Mailing Address - Zip Code:80111-2209
Mailing Address - Country:US
Mailing Address - Phone:720-802-0497
Mailing Address - Fax:303-265-9494
Practice Address - Street 1:6994 COUNTY ROAD 39
Practice Address - Street 2:
Practice Address - City:FORT LUPTON
Practice Address - State:CO
Practice Address - Zip Code:80621-8528
Practice Address - Country:US
Practice Address - Phone:720-802-0497
Practice Address - Fax:303-265-9494
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-11-12
Last Update Date:2025-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility