MEDICARE: CONNECT GROW THRIVE

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	251E00000X	Home Health Agency
2	385H00000X	Respite Care
3	251C00000X	Developmentally Disabled Services Day Training Agency

General Provider Information

NPI Number	:	1205499852
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CONNECT GROW THRIVE

Provider Business Mailing Address
First Line	:	4709 SPRINGER DR
Second Line	:
City	:	FORT COLLINS
State	:	CO
Zip	:	80524-8926
Country	:	US
Telephone Number	:	970-484-9005
Fax Number	:

Provider Business Practice Location Address
First Line	:	4709 SPRINGER DR
Second Line	:
City	:	FORT COLLINS
State	:	CO
Zip	:	80524-8926
Country	:	US
Telephone Number	:	970-484-9005
Fax Number	:

Authorized Official
Title or Position	:	PARTNER
Name	:	MRS. MONTESSA LENGEFELD
Credential	:
Telephone Number	:	970-484-9005

Provider Enumeration Date	:	04/19/2019
Last Update Date	:	04/19/2019

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Directions to “CONNECT GROW THRIVE ” Practice Location

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