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NPI Code Detail

MEDICARE: MR. JOSEPH LORENZO WILBERT CAC III

MEDICARE: MR. JOSEPH LORENZO WILBERT CAC III
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
1324500000XSubstance Abuse Rehabilitation FacilityCO

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
16905OTHERCOCAC III

General Provider Information

NPI Number : 1669774550
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. JOSEPH LORENZO WILBERT CAC III
Provider Business Mailing Address
First Line : 7251 E 49TH AVE
Second Line :
City : COMMERCE CITY
State : CO
Zip : 80022-4714
Country : US
Telephone Number : 303-321-2533
Fax Number : 303-468-6184
Provider Business Practice Location Address
First Line : 7251 E 49TH AVE
Second Line :
City : COMMERCE CITY
State : CO
Zip : 80022-4714
Country : US
Telephone Number : 303-321-2533
Fax Number : 303-468-6184
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/26/2010
Last Update Date : 11/26/2010

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