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General NPI Number Information
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NPI Number | 1093901332
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Entity Type | Organization
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Legal Business Name | COLORADO WELLNESS CONNECTION, LLC
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Dates
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Enumeration Date | 09/20/2007
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Last Update Date | 11/07/2014
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Provider Practice Location Address
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Address Line | 4960 E MINERAL CIR
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City | CENTENNIAL
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State | CO
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Zip | 80122-3833
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Country | US
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Telephone | 303-738-8301
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Fax |
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Provider Business Mailing Address
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Address Line | 4960 E MINERAL CIR
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City | CENTENNIAL
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State | CO
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Zip | 80122-3833
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Country | US
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Telephone | 303-738-8301
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | BONNIE C THOMAS
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Credential | RN
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Telephone | 303-738-8301
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QC1500X
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Taxonomy Name | Community Health Clinic/Center
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License Number |
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License Number State |
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