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General NPI Number Information
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NPI Number | 1558850339
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Entity Type | Organization
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Legal Business Name | DANCO SUPPORTIVE SERVICES COLORADO INC
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Dates
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Enumeration Date | 05/07/2018
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Last Update Date | 07/18/2018
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Provider Practice Location Address
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Address Line | 3302 SOUTH GRAND AVENUE
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City | GLENWOOD SPRINGS
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State | CO
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Zip | 81601
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Country | US
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Telephone | 970-930-6355
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Fax | 970-366-3929
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Provider Business Mailing Address
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Address Line | 3302 SOUTH GRAND AVENUE
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City | GLENWOOD SPRINGS
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State | CO
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Zip | 81601
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Country | US
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Telephone | 970-930-6355
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Fax | 970-366-3929
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Authorized Official
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Title or Position | PROGRAM DIRECTOR
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Name | AMANDA LEIGH OWENSBY
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Credential | CAC II
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Telephone | 970-930-6355
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR0405X
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Taxonomy Name | Substance Use Disorder Rehabilitation Clinic/Center
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License Number | 1985-01
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License Number State | CO
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