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General NPI Number Information
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NPI Number | 1629382882
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Entity Type | Organization
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Legal Business Name | PHASEONE
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Dates
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Enumeration Date | 07/29/2010
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Last Update Date | 07/29/2010
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Provider Practice Location Address
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Address Line | 1221 GALAPAGO ST
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City | DENVER
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State | CO
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Zip | 80204-3520
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Country | US
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Telephone | 303-668-4698
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Fax |
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Provider Business Mailing Address
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Address Line | 3936 MEADE ST
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City | DENVER
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State | CO
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Zip | 80211-1946
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Country | US
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Telephone | 303-668-4698
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MS. ANDREA LOREN MORALES
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Credential | COUNSELOR II
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Telephone | 303-668-4698
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251C00000X
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Taxonomy Name | Developmentally Disabled Services Day Training Agency
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License Number | 251C00000X
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License Number State | CO
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