MEDICARE: IDEAL SUPPORT SERVICES, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251B00000X	Case Management Agency		CO

General Provider Information

NPI Number	:	1104151851
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	IDEAL SUPPORT SERVICES, INC.

Provider Business Mailing Address
First Line	:	2323 S TROY ST
Second Line	:	BUILDING #1, SUITE 224
City	:	AURORA
State	:	CO
Zip	:	80014-1946
Country	:	US
Telephone Number	:	303-755-0594
Fax Number	:	303-755-1893

Provider Business Practice Location Address
First Line	:	2323 S TROY ST
Second Line	:
City	:	AURORA
State	:	CO
Zip	:	80014-1946
Country	:	US
Telephone Number	:	303-755-0594
Fax Number	:	303-755-1893

Authorized Official
Title or Position	:	DIRECTOR
Name	:	MR. YUKO JONAH
Credential	:
Telephone Number	:	303-755-0594

Provider Enumeration Date	:	10/14/2009
Last Update Date	:	10/14/2009

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