MEDICARE: BETTINA SERVICES WITH LOVE AND COMPASSION 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	251C00000X	Developmentally Disabled Services Day Training Agency		CO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1952773376
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BETTINA SERVICES WITH LOVE AND COMPASSION LLC

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	:	DIRECTOR
Name	:	BETTINA HARO OLIVA BOUDEZOQUE
Credential	:
Telephone Number	:	720-352-1725

Provider Enumeration Date	:	10/25/2015
Last Update Date	:	10/25/2015

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