Healthcare Provider Details

I. General information

NPI: 1205331444
Provider Name (Legal Business Name): NORTHWEST COLORADO CENTER FOR INDEPENDENCE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/29/2018
Last Update Date: 03/29/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1306 LINCOLN AVE UNIT A
STEAMBOAT SPRINGS CO
80487-5030
US

IV. Provider business mailing address

PO BOX 771475
STEAMBOAT SPRINGS CO
80477-1475
US

V. Phone/Fax

Practice location:
  • Phone: 970-817-4838
  • Fax: 970-871-4841
Mailing address:
  • Phone: 970-871-4838
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171WH0202X
TaxonomyHome Modifications Contractor
License Number
License Number State

VIII. Authorized Official

Name: MR. JADD ORION RELLER
Title or Position: LOGISTICS MANAGER
Credential:
Phone: 970-620-3897