Healthcare Provider Details

I. General information

NPI: 1902958358
Provider Name (Legal Business Name): GARY W. LEE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/17/2007
Last Update Date: 02/28/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2150 CURTIS ST
DENVER CO
80205-2519
US

IV. Provider business mailing address

2150 CURTIS ST
DENVER CO
80205-2519
US

V. Phone/Fax

Practice location:
  • Phone: 303-296-2244
  • Fax: 303-296-1709
Mailing address:
  • Phone: 303-296-2244
  • Fax: 303-296-1709

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License NumberLCSW-578
License Number StateID

VIII. Authorized Official

Name: GARY W LEE
Title or Position: OWNER
Credential: LCSW
Phone: 303-296-2244