MEDICARE: NORTHER COLORADO AIDS PROJECT

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	991851	CO

General Provider Information

NPI Number	:	1639475056
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NORTHER COLORADO AIDS PROJECT

Provider Business Mailing Address
First Line	:	400 REMINGTON ST
Second Line	:	SUITE 100
City	:	FORT COLLINS
State	:	CO
Zip	:	80524-2983
Country	:	US
Telephone Number	:	970-484-4469
Fax Number	:

Provider Business Practice Location Address
First Line	:	400 REMINGTON ST
Second Line	:	SUITE 100
City	:	FORT COLLINS
State	:	CO
Zip	:	80524-2983
Country	:	US
Telephone Number	:	970-484-4469
Fax Number	:

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	JEFF BASINGER
Credential	:
Telephone Number	:	970-484-4469

Provider Enumeration Date	:	02/02/2011
Last Update Date	:	02/02/2011

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