Healthcare Provider Details

I. General information

NPI: 1396077319
Provider Name (Legal Business Name): MM WADDELL HEALTH SERVICES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/01/2010
Last Update Date: 02/01/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3205 S HIGH ST
ENGLEWOOD CO
80113-3028
US

IV. Provider business mailing address

3205 S HIGH ST
ENGLEWOOD CO
80113-3028
US

V. Phone/Fax

Practice location:
  • Phone: 720-384-7526
  • Fax: 303-839-7936
Mailing address:
  • Phone: 720-384-7526
  • Fax: 303-839-7936

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code282E00000X
TaxonomyLong Term Care Hospital
License Number42011
License Number StateCO

VIII. Authorized Official

Name: DR. MARTHA MELROSE WADDELL
Title or Position: OWNER/PHYSICIAN
Credential: M.D.
Phone: 720-384-7526