MEDICARE: CONSORTIUM FOR OLDER ADULT WELLNESS

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	174H00000X	Health Educator

General Provider Information

NPI Number	:	1588176945
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CONSORTIUM FOR OLDER ADULT WELLNESS

Provider Business Mailing Address
First Line	:	3222 S VANCE ST STE 240
Second Line	:
City	:	LAKEWOOD
State	:	CO
Zip	:	80227-5007
Country	:	US
Telephone Number	:	303-984-1845
Fax Number	:	303-984-5962

Provider Business Practice Location Address
First Line	:	3222 S VANCE ST STE 240
Second Line	:
City	:	LAKEWOOD
State	:	CO
Zip	:	80227-5007
Country	:	US
Telephone Number	:	303-984-1845
Fax Number	:	303-984-5962

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	LYNNZY ORR MCINTOSH
Credential	:
Telephone Number	:	303-984-1845

Provider Enumeration Date	:	10/25/2017
Last Update Date	:	10/25/2017

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