Healthcare Provider Details

I. General information

NPI: 1154162782
Provider Name (Legal Business Name): W, L, & J, L, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/06/2024
Last Update Date: 06/06/2024
Certification Date: 06/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4401 S QUEBEC ST
DENVER CO
80237-2684
US

IV. Provider business mailing address

4401 S QUEBEC ST
DENVER CO
80237-2684
US

V. Phone/Fax

Practice location:
  • Phone: 720-484-4996
  • Fax: 303-794-6494
Mailing address:
  • Phone: 720-484-4996
  • Fax: 303-794-6494

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code320800000X
TaxonomyMental Illness Community Based Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name: PAULA JAYNE SCHAEFBAUER
Title or Position: CFAO
Credential:
Phone: 720-484-4996