MEDICARE: SUNKIST MOMENTS

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
1	251C00000X	Developmentally Disabled Services Day Training Agency		CO

General Provider Information

NPI Number	:	1124410295
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SUNKIST MOMENTS

Provider Business Mailing Address
First Line	:	325 E 1ST ST
Second Line	:	#411
City	:	AULT
State	:	CO
Zip	:	80610-9667
Country	:	US
Telephone Number	:	641-680-3087
Fax Number	:	970-834-1287

Provider Business Practice Location Address
First Line	:	325 E 1ST ST
Second Line	:	#411
City	:	AULT
State	:	CO
Zip	:	80610-9667
Country	:	US
Telephone Number	:	641-680-3087
Fax Number	:	970-834-1287

Authorized Official
Title or Position	:	PROGRAM DIRECTOR
Name	:	MS. NICKOLE MARIE BEHRENDS
Credential	:
Telephone Number	:	641-680-3087

Provider Enumeration Date	:	02/26/2015
Last Update Date	:	02/26/2015

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Directions to “SUNKIST MOMENTS ” Practice Location

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