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General NPI Number Information
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NPI Number | 1972808111
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Entity Type | Organization
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Legal Business Name | M T WYANT ENTERPRISES INC.
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Dates
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Enumeration Date | 01/19/2011
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Last Update Date | 01/19/2011
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Provider Practice Location Address
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Address Line | 107 W 29TH ST STE 200
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City | LOVELAND
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State | CO
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Zip | 80538-2279
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Country | US
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Telephone | 970-229-0025
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Fax |
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Provider Business Mailing Address
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Address Line | 107 W 29TH ST STE 200
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City | LOVELAND
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State | CO
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Zip | 80538-2279
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Country | US
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Telephone | 970-229-0025
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Fax |
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Authorized Official
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Title or Position | VICE PRESIDENT
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Name | MRS. THERESA WYANT
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Credential |
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Telephone | 970-229-0025
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number |
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License Number State | CO
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