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General NPI Number Information
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NPI Number | 1255788402
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Entity Type | Organization
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Legal Business Name | COLORADO LIONS CAMP INC
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Dates
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Enumeration Date | 05/18/2016
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Last Update Date | 05/18/2016
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Provider Practice Location Address
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Address Line | 28541 HIGHWAY 67
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City | WOOODAND PARK
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State | CO
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Zip | 80863
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Country | US
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Telephone | 719-687-2087
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Fax | 719-687-7435
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Provider Business Mailing Address
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Address Line | PO BOX 9043
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City | WOODLAND PARK
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State | CO
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Zip | 80863-0240
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Country | US
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Telephone | 719-687-2087
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Fax | 719-687-7435
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | SHARRON NICKERSON
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Credential |
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Telephone | 719-687-2087
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 385HR2050X
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Taxonomy Name | Respite Care Camp
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License Number | R47606
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License Number State | CO
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