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General NPI Number Information
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NPI Number | 1255669693
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Entity Type | Organization
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Legal Business Name | WELCOME HOME WARRIOR
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Dates
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Enumeration Date | 11/23/2009
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Last Update Date | 11/23/2009
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Provider Practice Location Address
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Address Line | 471 S BALDWIN ST
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City | WOODLAND PARK
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State | CO
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Zip | 80863-3125
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Country | US
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Telephone | 719-687-1000
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 7217
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City | WOODLAND PARK
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State | CO
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Zip | 80863-0201
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Country | US
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Telephone | 719-687-1000
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Fax |
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Authorized Official
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Title or Position | DIRECTOR
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Name | MS. DONNA M. FINICLE
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Credential | LCSW, BCD
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Telephone | 719-686-0478
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | 992385
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License Number State | CO
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