=====================================================
General NPI Number Information
=====================================================
NPI Number | 1841733391
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | FRONT RANGE PERS
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/30/2016
-----------------------------------------------------
Last Update Date | 11/30/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3557 POLK CIR E
-----------------------------------------------------
City | WELLINGTON
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 80549-1682
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 970-371-6319
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3557 POLK CIR E
-----------------------------------------------------
City | WELLINGTON
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 80549-1682
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 970-371-6319
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | MICHAEL ROCHA
-----------------------------------------------------
Credential | PTA
-----------------------------------------------------
Telephone | 970-371-6319
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 333300000X
-----------------------------------------------------
Taxonomy Name | Emergency Response System Companies
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------