Healthcare Provider Details

I. General information

NPI: 1629258397
Provider Name (Legal Business Name): MARYTIMES SERVICES, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/09/2007
Last Update Date: 11/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3085 KIOWA DR
LOVELAND CO
80538-8642
US

IV. Provider business mailing address

3085 KIOWA DR
LOVELAND CO
80538-8642
US

V. Phone/Fax

Practice location:
  • Phone: 970-669-2627
  • Fax: 323-313-0970
Mailing address:
  • Phone: 970-669-2627
  • Fax: 323-313-0970

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number80488714
License Number StateCO

VIII. Authorized Official

Name: MR. ROBERT L HARRIS
Title or Position: OWNER
Credential:
Phone: 970-669-2627