Healthcare Provider Details

I. General information

NPI: 1225225600
Provider Name (Legal Business Name): HEALTH ELECTIVES AND LIFE OPTIONS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/28/2007
Last Update Date: 12/08/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

321 E NORTH ST
CORTEZ CO
81321-3230
US

IV. Provider business mailing address

321 E NORTH ST
CORTEZ CO
81321-3230
US

V. Phone/Fax

Practice location:
  • Phone: 970-564-8177
  • Fax: 970-564-8179
Mailing address:
  • Phone: 970-564-8177
  • Fax: 970-564-8179

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. LEONARD W CAIN
Title or Position: MD/OWNER
Credential:
Phone: 970-564-8177