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General NPI Number Information
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NPI Number | 1396004933
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Entity Type | Organization
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Legal Business Name | MESA DEVELOPMENTAL SERVICES
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Dates
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Enumeration Date | 05/15/2012
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Last Update Date | 10/25/2012
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Provider Practice Location Address
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Address Line | 950 GRAND AVE
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City | GRAND JUNCTION
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State | CO
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Zip | 81501-3451
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Country | US
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Telephone | 970-243-3702
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Fax | 970-243-7751
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Provider Business Mailing Address
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Address Line | 950 GRAND AVE
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City | GRAND JUNCTION
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State | CO
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Zip | 81501-3451
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Country | US
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Telephone | 970-243-3702
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Fax | 970-243-7751
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Authorized Official
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Title or Position | CEO/ADMINISTRATOR
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Name | MR. JEFFREY S NICHOLS
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Credential |
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Telephone | 970-256-8601
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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 | 04G510
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License Number State | CO
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