MEDICARE: BETTINA SERVICES WITH LOVE AND COMPASSION

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	253Z00000X	In Home Supportive Care Agency

General Provider Information

NPI Number	:	1609254762
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BETTINA SERVICES WITH LOVE AND COMPASSION

Provider Business Mailing Address
First Line	:	53 GRAY ST
Second Line	:
City	:	LAKEWOOD
State	:	CO
Zip	:	80226-2209
Country	:	US
Telephone Number	:	720-352-1725
Fax Number	:

Provider Business Practice Location Address
First Line	:	53 GRAY ST
Second Line	:
City	:	LAKEWOOD
State	:	CO
Zip	:	80226-2209
Country	:	US
Telephone Number	:	720-352-1725
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	BETTINA HARO OLIVA BOUDEZOQUE
Credential	:	OWNER
Telephone Number	:	720-352-1725

Provider Enumeration Date	:	05/09/2015
Last Update Date	:	05/09/2015

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