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NPI Code Detail

MEDICARE: JAYWALKER LODGE, LLC

MEDICARE: JAYWALKER LODGE, LLC
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 Facility1548-01CO

General Provider Information

NPI Number : 1750657482
Entity Type Code : Organization
Provider Name (Legal Business Name) : JAYWALKER LODGE, LLC
Provider Business Mailing Address
First Line : PO BOX 969
Second Line :
City : CARBONDALE
State : CO
Zip : 81623-0969
Country : US
Telephone Number : 970-704-9292
Fax Number :
Provider Business Practice Location Address
First Line : 811 MAIN CT
Second Line :
City : CARBONDALE
State : CO
Zip : 81623-1851
Country : US
Telephone Number : 970-704-9292
Fax Number :
Authorized Official
Title or Position : DIRECTOR OF INSURANCE
Name : LAURI A WINSLOW
Credential :
Telephone Number : 970-704-9292
Provider Enumeration Date : 03/27/2012
Last Update Date : 03/10/2025

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