Healthcare Provider Details

I. General information

NPI: 1477903383
Provider Name (Legal Business Name): COMMUNITY CHOICE RESOURCE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/21/2016
Last Update Date: 02/06/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9915 W WAGON TRAIL DR
DENVER CO
80123-1955
US

IV. Provider business mailing address

9915 W WAGON TRAIL DR
DENVER CO
80123-1955
US

V. Phone/Fax

Practice location:
  • Phone: 303-963-6960
  • Fax:
Mailing address:
  • Phone: 303-963-6960
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code376J00000X
TaxonomyHomemaker
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number
License Number State

VIII. Authorized Official

Name: JASON LUCERO
Title or Position: OWNER/OPERATOR
Credential:
Phone: 303-963-6960