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BOLDER LIFE
NPI 1376093898
Substance Abuse Rehabilitation Facility in Boulder, CO

Active since October 07, 2016CLIA 06D2134210 · Waiver
2429 BROADWAY ST, BOULDER, CO 80304(720) 739-6500(720) 204-3930 Get Directions Write a Review

NPPES record last updated: September 10, 2021. Verified against the NPPES registry weekly; last sync: July 19, 2026.

Record update history: Sep 10, 2021, Jul 15, 2021, Jun 29, 2021 (3 updates tracked since 2021).

About Bolder Life NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

BOLDER LIFE (NPI 1376093898) is a healthcare organization registered as a substance abuse rehabilitation facility in Boulder, Colorado and active in the NPI registry since October 2016. The organization holds a CLIA Waiver certificate valid through July 26, 2027 and lists Mary Wilson, Business Office Manager, as its authorized official.

NPPES Registry Identity

NPI1376093898
Entity TypeOrganization
Primary Taxonomy324500000X
Legal Business NameBOULDER INTEGRATED HEALTH LLC
Location Address2429 BROADWAY STBoulder, CO 80304-4108
Mailing Address2429 Broadway StBoulder, CO 80304-4108 · (720) 739-6500 · Fax (720) 204-3930
Phone(720) 739-6500
Fax(720) 204-3930
Organization SubpartNo
Authorized OfficialMary WilsonBusiness Office Manager · (720) 739-6500
Enumeration DateOctober 7, 2016
Last NPPES UpdateSeptember 10, 20213 updates tracked since enumeration
NPPES CertifiedJuly 15, 2021
✔ NPI 1376093898 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtySubstance Abuse Rehabilitation FacilityResidential Treatment Facilities
Taxonomy Code324500000X
Definition

A facility or distinct part of a facility that provides a 24 hr therapeutically planned living and rehabilitative intervention environment for the treatment of individuals with disorders in the abuse of drugs, alcohol, and other substances.

2429 BROADWAY ST, Boulder, CO 80304
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Other Names 1

Doing Business AsBolder Life

CLIA Laboratory Certificates CMS CLIA

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate of Waiver 06D2134210

Boulder Integrated Health · Boulder, CO
Active · expires Jul 26, 2027
CLIA Number06D2134210
Laboratory TypeAncillary Testing Site In Health Care Center
Certificate Effective DateJuly 27, 2025
Certificate Expiration DateJuly 26, 2027
Laboratory DirectorDr. Iaonnus A. Malidelis
Laboratory Phone(720) 739-6500
Laboratory LocationBoulder Integrated Health2429 Broadway, Boulder, CO 80304
CLIA data matches this NPI record on: Address Name Phone
This certificate is issued to a laboratory to perform only waived tests.

Other Providers at the Same Location NPPES 4

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

STEPHANIE ADDISS
Counselor (Mental Health)
2429 BROADWAY ST
BOULDER, CO 80304
Boulder County (949) 241-2220
KATHLEEN CLARE MCCARTHY MA, LPCC, LAC
Counselor (Addiction (Substance Use Disorder))
2429 BROADWAY ST
BOULDER, CO 80304
Boulder County (720) 739-6500
DR. BRITTANY NICOLE RUBIN PSYD
Psychologist (Clinical)
2429 BROADWAY ST
BOULDER, CO 80304
Boulder County (720) 739-6500
DAKOTAH C ACOSTA MA
Counselor (Mental Health)
2429 BROADWAY ST
BOULDER, CO 80304
Boulder County (720) 739-6500

Frequently Asked Questions

What is BOULDER INTEGRATED HEALTH LLC's NPI number?

The NPI number assigned to this healthcare provider is 1376093898, enumerated as an "organization" on October 07, 2016.

Where is the provider located?

The provider is located at 2429 BROADWAY ST BOULDER, CO 80304 and the phone number is (720) 739-6500.

What is the provider's specialty?

Substance Abuse Rehabilitation Facility with taxonomy code 324500000X.