Healthcare Provider Details

I. General information

NPI: 1467908004
Provider Name (Legal Business Name): ELEOS SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/01/2016
Last Update Date: 01/10/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4319 PEARLGATE CT
FORT COLLINS CO
80526-3341
US

IV. Provider business mailing address

4319 PEARLGATE CT
FORT COLLINS CO
80526-3341
US

V. Phone/Fax

Practice location:
  • Phone: 970-825-5805
  • Fax: 970-797-2757
Mailing address:
  • Phone: 970-825-5805
  • Fax: 970-797-2757

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 Code385HR2060X
TaxonomyChild Intellectual and/or Developmental Disabilities Respite Care
License Number
License Number State

VIII. Authorized Official

Name: JENNIFER WITTENAUER
Title or Position: DIRECTOR
Credential:
Phone: 970-988-1689