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General NPI Number Information
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NPI Number | 1528891934
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Entity Type | Organization
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Legal Business Name | WIICARE COLORADO LLC
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Dates
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Enumeration Date | 08/21/2024
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Last Update Date | 08/21/2024
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Provider Practice Location Address
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Address Line | 1642 S PARKER RD STE 307
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City | DENVER
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State | CO
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Zip | 80231-2917
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Country | US
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Telephone | 480-452-9149
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Fax |
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Provider Business Mailing Address
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Address Line | 1501 W EMERALD KEY CT
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City | GILBERT
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State | AZ
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Zip | 85233-6114
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Country | US
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Telephone | 482-452-9149
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | NAWAL MOHAMMAD
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Credential |
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Telephone | 804-469-0044
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State |
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