MEDICARE: YULIYA GOSTISHCHEVA

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	261QA0600X	Adult Day Care Clinic/Center		CO
2	376J00000X	Homemaker	04B433	CO
3	385H00000X	Respite Care	04B433	CO
4	172A00000X	Driver
5	253Z00000X	In Home Supportive Care Agency	04T569	CO

General Provider Information

NPI Number	:	1720455504
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	YULIYA GOSTISHCHEVA

Provider Business Mailing Address
First Line	:	1210 S PARKER RD STE 200
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80231-2163
Country	:	US
Telephone Number	:	720-282-3578
Fax Number	:	720-282-3579

Provider Business Practice Location Address
First Line	:	1210 S PARKER RD STE 200
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80231-2163
Country	:	US
Telephone Number	:	720-282-3578
Fax Number	:	303-963-5641

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/27/2015
Last Update Date	:	10/12/2021

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