Healthcare Provider Details

I. General information

NPI: 1760840722
Provider Name (Legal Business Name): NOSTALGIA GROUP, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/05/2016
Last Update Date: 02/05/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1325 S COLORADO BLVD STE B304
DENVER CO
80222-3303
US

IV. Provider business mailing address

1325 S COLORADO BLVD STE B304
DENVER CO
80222-3303
US

V. Phone/Fax

Practice location:
  • Phone: 303-298-0027
  • Fax: 303-298-0037
Mailing address:
  • Phone: 303-298-0027
  • Fax: 303-298-0037

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 Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

Name: JAMES SHANNON
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 303-298-0027