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Individual

GRACE LANTAM

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F

Contact information

Practice address
12241 CRYSTAL DOWNS RD, PEYTON, CO 80831-4042
(720) 329-6429
(720) 329-6429
Mailing address
12241 CRYSTAL DOWNS RD, PEYTON, CO 80831
(720) 329-6429

Taxonomy

Speciality
Code
Description
License number
State
376J00000X
Homemaker
Primary
385H00000X
Respite Care

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
812697217
IRS
05
812697217
CO
Enumeration date
07/05/2016
Last updated
03/17/2018
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