Healthcare Provider Details

I. General information

NPI: 1487876660
Provider Name (Legal Business Name): NEUROCARE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/03/2007
Last Update Date: 11/15/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1510 COLUMBINE AVE
BOULDER CO
80302-7943
US

IV. Provider business mailing address

1510 COLUMBINE AVE
BOULDER CO
80302-7943
US

V. Phone/Fax

Practice location:
  • Phone: 303-586-1556
  • Fax: 215-839-8932
Mailing address:
  • Phone: 303-586-1556
  • Fax: 215-839-8932

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License NumberMD023070E
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberMD023070E
License Number StatePA

VIII. Authorized Official

Name: DR. ROBERT IRA WINER
Title or Position: PRESIDENT
Credential: MD
Phone: 303-586-1556