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General NPI Number Information
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NPI Number | 1063645240
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Entity Type | Organization
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Legal Business Name | PS NUTRITION
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Dates
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Enumeration Date | 09/03/2009
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Last Update Date | 09/03/2009
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Provider Practice Location Address
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Address Line | 2457 NEWTON ST
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City | DENVER
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State | CO
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Zip | 80211-4443
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Country | US
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Telephone | 303-910-8997
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Fax |
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Provider Business Mailing Address
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Address Line | 2457 NEWTON ST
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City | DENVER
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State | CO
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Zip | 80211-4443
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Country | US
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Telephone | 303-910-8997
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | PHILIP T SKAFF
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Credential | MSRD
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Telephone | 303-910-8997
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 253Z00000X
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Taxonomy Name | In Home Supportive Care Agency
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License Number | 1035109
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License Number State | IL
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