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General NPI Number Information
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NPI Number | 1598455206
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Entity Type | Organization
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Legal Business Name | CABOOSE CARE, LLC
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Dates
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Enumeration Date | 05/08/2023
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Last Update Date | 05/08/2023
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Provider Practice Location Address
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Address Line | 2013 LILY DR
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City | LOVELAND
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State | CO
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Zip | 80537-3333
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Country | US
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Telephone | 970-227-7669
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Fax |
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Provider Business Mailing Address
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Address Line | 455 E WATERSIDE DR UNIT 1412
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City | CHICAGO
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State | IL
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Zip | 60601-0017
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Country | US
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Telephone | 970-227-7669
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | JACOB WOOD
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Credential |
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Telephone | 970-227-7669
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 320900000X
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Taxonomy Name | Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
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License Number |
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License Number State |
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