Healthcare Provider Details

I. General information

NPI: 1184233769
Provider Name (Legal Business Name): SPECIAL NEEDS SUPPLY CO. OF THE ROCKIES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/29/2020
Last Update Date: 08/05/2020
Certification Date: 08/05/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6625 WARD RD
ARVADA CO
80004-2464
US

IV. Provider business mailing address

6625 WARD RD
ARVADA CO
80004-2464
US

V. Phone/Fax

Practice location:
  • Phone: 303-587-4025
  • Fax:
Mailing address:
  • Phone: 303-587-4025
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332BP3500X
TaxonomyParenteral & Enteral Nutrition Supplies (DME)
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code335G00000X
TaxonomyMedical Foods Supplier
License Number
License Number State

VIII. Authorized Official

Name: MRS. STEPHANIE DOCKSTADER
Title or Position: PRESIDENT/COO
Credential:
Phone: 303-587-4025