Healthcare Provider Details

I. General information

NPI: 1831008994
Provider Name (Legal Business Name): JERMALE REESE
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/03/2026
Last Update Date: 09/08/2026
Certification Date: 09/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12541 GLENCOE ST
THORNTON CO
80241-3295
US

IV. Provider business mailing address

12541 GLENCOE ST
THORNTON CO
80241-3295
US

V. Phone/Fax

Practice location:
  • Phone: 720-545-5333
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code385HR2065X
TaxonomyChild Physical Disabilities Respite Care
License Number
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: