MEDICARE: REBUILDING TOGETHER COLORADO SPRINGS

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	332B00000X	Durable Medical Equipment & Medical Supplies

General Provider Information

NPI Number	:	1811201569
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	REBUILDING TOGETHER COLORADO SPRINGS

Provider Business Mailing Address
First Line	:	1975 RESEARCH PKWY
Second Line	:	SUITE 300
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80920-1025
Country	:	US
Telephone Number	:	719-634-4115
Fax Number	:	888-315-6936

Provider Business Practice Location Address
First Line	:	1975 RESEARCH PKWY
Second Line	:	SUITE 300
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80920-1025
Country	:	US
Telephone Number	:	719-634-4115
Fax Number	:	888-315-6936

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	LAURIAN LEE MIZER
Credential	:
Telephone Number	:	719-634-4115

Provider Enumeration Date	:	08/04/2010
Last Update Date	:	08/04/2010

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