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General NPI Number Information
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NPI Number | 1245871599
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Entity Type | Organization
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Legal Business Name | AVIV MONTROSE
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Dates
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Enumeration Date | 10/07/2019
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Last Update Date | 05/18/2021
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Provider Practice Location Address
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Address Line | 540 MAIN ST STE 108
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City | DELTA
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State | CO
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Zip | 81416-1834
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Country | US
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Telephone | 970-240-4121
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 40186
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City | GRAND JUNCTION
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State | CO
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Zip | 81504-0186
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Country | US
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Telephone |
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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 | JOE GIAUQUE
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Credential |
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Telephone | 970-201-7297
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number |
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License Number State |
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