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NPI Code Detail

MEDICARE: JASON LAROSE

MEDICARE: JASON LAROSE
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YA0400XAddiction (Substance Use Disorder) CounselorACA.0008361CO
2171M00000XCase Manager/Care Coordinator
3172A00000XDriver

General Provider Information

NPI Number : 1073163150
Entity Type Code : Individual
Provider Name (Legal Business Name) : JASON LAROSE
Provider Business Mailing Address
First Line : 4856 INNOVATION DR
Second Line :
City : FORT COLLINS
State : CO
Zip : 80525-5539
Country : US
Telephone Number : 970-494-4200
Fax Number : 844-270-1824
Provider Business Practice Location Address
First Line : 4856 INNOVATION DR
Second Line :
City : FORT COLLINS
State : CO
Zip : 80525-5539
Country : US
Telephone Number : 970-494-4200
Fax Number : 844-270-1824
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/19/2019
Last Update Date : 03/03/2026

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