Healthcare Provider Details

I. General information

NPI: 1295230043
Provider Name (Legal Business Name): NORTHWEST COLORADO CENTER FOR INDEPENDENCE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/26/2018
Last Update Date: 07/12/2021
Certification Date: 07/12/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1855 SHIELD DR UNIT 300
STEAMBOAT SPRINGS CO
80487-5247
US

IV. Provider business mailing address

1855 SHIELD DR UNIT 300
STEAMBOAT SPRINGS CO
80487-5247
US

V. Phone/Fax

Practice location:
  • Phone: 907-871-4838
  • Fax:
Mailing address:
  • Phone: 970-871-4838
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name: IAN ENGLE
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 303-720-9405