=====================================================
General NPI Number Information
=====================================================
NPI Number | 1649471194
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | TIMBERLINE ADULT DAY SERVICES
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/31/2007
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 0151 PEAK ONE BLVD
-----------------------------------------------------
City | FRISCO
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 80443-1327
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 970-668-2952
-----------------------------------------------------
Fax | 970-668-2954
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 1327
-----------------------------------------------------
City | FRISCO
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 80443-1327
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 970-668-2952
-----------------------------------------------------
Fax | 970-668-2954
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DIRECTOR
-----------------------------------------------------
Name | CANDACE BARNES
-----------------------------------------------------
Credential | NHA - LPN
-----------------------------------------------------
Telephone | 970-668-2952
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QA0600X
-----------------------------------------------------
Taxonomy Name | Adult Day Care Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------