MEDICARE: PHASE ONE

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	251C00000X	Developmentally Disabled Services Day Training Agency	NA

General Provider Information

NPI Number	:	1467731059
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PHASE ONE

Provider Business Mailing Address
First Line	:	1560 S QUEBEC WAY
Second Line	:	# 55
City	:	DENVER
State	:	CO
Zip	:	80231-5681
Country	:	US
Telephone Number	:	303-518-2142
Fax Number	:

Provider Business Practice Location Address
First Line	:	1560 S QUEBEC WAY
Second Line	:	# 55
City	:	DENVER
State	:	CO
Zip	:	80231-5681
Country	:	US
Telephone Number	:	303-518-2142
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	MR. PRABIN RISAL
Credential	:
Telephone Number	:	303-518-2142

Provider Enumeration Date	:	08/12/2011
Last Update Date	:	08/12/2011

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Directions to “PHASE ONE ” Practice Location

Language	Start Address	Practice Location

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