MEDICARE: COMMUNITY SOLUTIONS, LIMITED LIABILITY COMPANY

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	101YA0400X	Addiction (Substance Use Disorder) Counselor	1771-02	CO

General Provider Information

NPI Number	:	1134672017
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COMMUNITY SOLUTIONS, LIMITED LIABILITY COMPANY

Provider Business Mailing Address
First Line	:	219 E RAILROAD AVE
Second Line	:
City	:	FORT MORGAN
State	:	CO
Zip	:	80701-3134
Country	:	US
Telephone Number	:	303-834-9369
Fax Number	:	303-834-9396

Provider Business Practice Location Address
First Line	:	219 E RAILROAD AVE
Second Line	:
City	:	FORT MORGAN
State	:	CO
Zip	:	80701-3134
Country	:	US
Telephone Number	:	303-834-9369
Fax Number	:	303-834-9396

Authorized Official
Title or Position	:	DIRECTOR/OWNER
Name	:	MS. MARY ANN URSICH
Credential	:	LAC
Telephone Number	:	303-834-9369

Provider Enumeration Date	:	07/27/2016
Last Update Date	:	08/11/2016

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