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General NPI Number Information
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NPI Number | 1013495993
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Entity Type | Individual
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Provider Name | JEFF G REYNOLDS
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Gender | Male
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Dates
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Enumeration Date | 08/01/2018
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Last Update Date | 08/01/2018
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Provider Practice Location Address
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Address Line | 11 WESTMARK AVE
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City | COLORADO SPRINGS
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State | CO
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Zip | 80906-4738
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Country | US
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Telephone | 719-660-6826
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Fax | 719-218-1010
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Provider Business Mailing Address
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Address Line | 2540 CARDIGAN DR
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City | COLORADO SPRINGS
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State | CO
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Zip | 80920-5348
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Country | US
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Telephone | 719-660-6826
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Fax | 719-218-1010
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 376G00000X
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Taxonomy Name | Nursing Home Administrator
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License Number | 23U713
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License Number State | CO
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