Healthcare Provider Details

I. General information

NPI: 1689166407
Provider Name (Legal Business Name): TBI COLORADO
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/06/2018
Last Update Date: 06/06/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7681 S WELLINGTON ST
CENTENNIAL CO
80122-3054
US

IV. Provider business mailing address

10730 JORDAN CT
PARKER CO
80134-7614
US

V. Phone/Fax

Practice location:
  • Phone: 720-412-5730
  • Fax:
Mailing address:
  • Phone: 720-412-5730
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number23A468
License Number StateCO

VIII. Authorized Official

Name: TEDDI SAMUEL
Title or Position: CEO
Credential:
Phone: 720-412-5730