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General NPI Number Information
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NPI Number | 1134672017
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Entity Type | Organization
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Legal Business Name | COMMUNITY SOLUTIONS, LIMITED LIABILITY COMPANY
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Dates
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Enumeration Date | 07/27/2016
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Last Update Date | 08/11/2016
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Provider Practice Location Address
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Address Line | 219 E RAILROAD AVE
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City | FORT MORGAN
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State | CO
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Zip | 80701-3134
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Country | US
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Telephone | 303-834-9369
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Fax | 303-834-9396
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Provider Business Mailing Address
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Address Line | 219 E RAILROAD AVE
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City | FORT MORGAN
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State | CO
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Zip | 80701-3134
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Country | US
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Telephone | 303-834-9369
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Fax | 303-834-9396
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Authorized Official
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Title or Position | DIRECTOR/OWNER
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Name | MS. MARY ANN URSICH
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Credential | LAC
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Telephone | 303-834-9369
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 1771-02
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License Number State | CO
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