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NPI Code Detail

MEDICARE: MAURA STACK ODEN LLC

MEDICARE: MAURA STACK ODEN 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
1251S00000XCommunity/Behavioral Health Agency

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1194186148
Entity Type Code : Organization
Provider Name (Legal Business Name) : MAURA STACK ODEN LLC
Provider Business Mailing Address
First Line : 1309 OAK WAY AVE
Second Line :
City : GLENWOOD SPRINGS
State : CO
Zip : 81601-4049
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 1309 OAK WAY AVE
Second Line :
City : GLENWOOD SPRINGS
State : CO
Zip : 81601-4049
Country : US
Telephone Number : 720-670-9046
Fax Number :
Authorized Official
Title or Position : OWNER
Name : MAURA WAMSLEY
Credential : BCBA
Telephone Number : 720-670-9046
Provider Enumeration Date : 03/17/2016
Last Update Date : 07/23/2021

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Directions to “MAURA STACK ODEN LLC ” Practice Location

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