MEDICARE: ABLELIGHT INC.

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	:	1265216303
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ABLELIGHT INC.

Provider Business Mailing Address
First Line	:	600 HOFFMANN DR
Second Line	:
City	:	WATERTOWN
State	:	WI
Zip	:	53094-6223
Country	:	US
Telephone Number	:	920-261-3050
Fax Number	:

Provider Business Practice Location Address
First Line	:	6120 TUTT BLVD
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80923-3568
Country	:	US
Telephone Number	:	720-994-8063
Fax Number	:

Authorized Official
Title or Position	:	DIRECTOR OF TREASURY
Name	:	MICHAEL MINNING
Credential	:
Telephone Number	:	920-206-4459

Provider Enumeration Date	:	08/21/2023
Last Update Date	:	08/21/2023

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