Healthcare Provider Details

I. General information

NPI: 1972122232
Provider Name (Legal Business Name): CHC NCS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/15/2020
Last Update Date: 05/24/2021
Certification Date: 05/24/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11681 VOYAGER PKWY STE 110
COLORADO SPRINGS CO
80921-3862
US

IV. Provider business mailing address

72 RAVEN HILLS CT
COLORADO SPRINGS CO
80919-1316
US

V. Phone/Fax

Practice location:
  • Phone: 719-510-6730
  • Fax:
Mailing address:
  • Phone: 719-964-3284
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: JEFF ALEXANDER
Title or Position: MANAGER
Credential:
Phone: 719-964-3284