MEDICARE: EVIDENCE BASED SERVICES, LLC

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	251S00000X	Community/Behavioral Health Agency

General Provider Information

NPI Number	:	1164907770
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EVIDENCE BASED SERVICES, LLC

Provider Business Mailing Address
First Line	:	1714 SHEA CENTER DR APT 201
Second Line	:
City	:	HIGHLANDS RANCH
State	:	CO
Zip	:	80129-3525
Country	:	US
Telephone Number	:	720-436-0416
Fax Number	:

Provider Business Practice Location Address
First Line	:	1714 SHEA CENTER DR APT 201
Second Line	:
City	:	HIGHLANDS RANCH
State	:	CO
Zip	:	80129-3525
Country	:	US
Telephone Number	:	720-436-0416
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	ERIC SPERLING
Credential	:
Telephone Number	:	720-436-0416

Provider Enumeration Date	:	09/28/2018
Last Update Date	:	09/28/2018

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