Healthcare Provider Details

I. General information

NPI: 1578492500
Provider Name (Legal Business Name): SALUKI CELLAR CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/15/2026
Last Update Date: 05/15/2026
Certification Date: 05/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6035 ERIN PARK DR STE 102
COLORADO SPRINGS CO
80918-3427
US

IV. Provider business mailing address

6035 ERIN PARK DR STE 102
COLORADO SPRINGS CO
80918-3427
US

V. Phone/Fax

Practice location:
  • Phone: 719-247-6567
  • Fax: 719-247-6903
Mailing address:
  • Phone: 719-247-6567
  • Fax: 719-247-6903

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

Name: RICHARD JOHN BUSSE
Title or Position: PRESIDENT
Credential:
Phone: 719-247-6527