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General NPI Number Information
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NPI Number | 1063820819
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Entity Type | Organization
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Legal Business Name | TELLER SENIOR COALITION
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Dates
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Enumeration Date | 07/24/2014
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Last Update Date | 07/24/2014
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Provider Practice Location Address
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Address Line | 750 E US HIGHWAY 24 BLDG 2 STE 100
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City | WOODLAND PARK
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State | CO
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Zip | 80863-7750
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Country | US
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Telephone | 719-687-3330
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 6956
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City | WOODLAND PARK
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State | CO
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Zip | 80866-6956
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Country | US
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Telephone | 719-687-3330
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Fax |
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | BARBARA BERGER
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Credential |
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Telephone | 719-687-3330
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 343900000X
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Taxonomy Name | Non-emergency Medical Transport (VAN)
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License Number |
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License Number State |
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