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General NPI Number Information
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NPI Number | 1023388352
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Entity Type | Organization
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Legal Business Name | THOMAS JEFFERSON DAY CENTER
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Dates
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Enumeration Date | 01/03/2012
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Last Update Date | 01/03/2012
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Provider Practice Location Address
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Address Line | 5922 S BIRCH WAY
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City | CENTENNIAL
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State | CO
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Zip | 80121-3369
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Country | US
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Telephone | 720-982-5732
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Fax | 303-200-8437
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Provider Business Mailing Address
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Address Line | 5922 S BIRCH WAY
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City | CENTENNIAL
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State | CO
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Zip | 80121-3369
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Country | US
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Telephone | 720-982-5732
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Fax | 303-200-8437
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Authorized Official
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Title or Position | DIRECTOR
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Name | MR. KENNETH ONG
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Credential |
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Telephone | 720-982-5732
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 347C00000X
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Taxonomy Name | Private Vehicle
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License Number | 922447943
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License Number State | CO
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