MEDICARE: SOUL ATTENTION, LLC

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	251J00000X	Nursing Care Agency	RN-117289	CO
2	251S00000X	Community/Behavioral Health Agency	LPC-6034	CO

General Provider Information

NPI Number	:	1861758161
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SOUL ATTENTION, LLC

Provider Business Mailing Address
First Line	:	1355 S 8TH ST STE 207
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80905-7022
Country	:	US
Telephone Number	:	719-351-4251
Fax Number	:

Provider Business Practice Location Address
First Line	:	1355 S 8TH ST STE 207
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80905-7022
Country	:	US
Telephone Number	:	719-351-4251
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	NANCY J. BEACH
Credential	:	LPC, RN
Telephone Number	:	719-351-4251

Provider Enumeration Date	:	04/11/2012
Last Update Date	:	04/11/2012

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