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General NPI Number Information
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NPI Number | 1922502038
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Entity Type | Organization
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Legal Business Name | CUSTOM CONSTRUCTION SERVICES
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Dates
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Enumeration Date | 03/22/2018
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Last Update Date | 06/16/2018
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Provider Practice Location Address
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Address Line | 5225 SODBUSTER TRL
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City | COLORADO SPRINGS
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State | CO
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Zip | 80917-1817
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Country | US
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Telephone | 719-474-9988
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Fax |
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Provider Business Mailing Address
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Address Line | 5225 SODBUSTER TRL
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City | COLORADO SPRINGS
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State | CO
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Zip | 80917-1817
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Country | US
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Telephone | 719-474-9988
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Fax |
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | BARBARA JOAN MARTINEZ
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Credential |
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Telephone | 719-474-9988
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 171W00000X
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Taxonomy Name | Contractor
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License Number | 22126
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License Number State | CO
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