Organization
SOUTHERN COLORDO INDEPENDENT COMMUNITY, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
WILLIAM GERARD SMITH (MEMBER)
(720) 201-4065
Entity
Organization
Contact information
Practice address
2325 CRESTWOOD LN, PUEBLO, CO 81008-2862
(720) 201-4065
Mailing address
2325 CRESTWOOD LN, PUEBLO, CO 81008-2862
(720) 201-4065
Taxonomy
Speciality
Code
Description
License number
State
253Z00000X
In Home Supportive Care Agency
Primary
31695638
CO
Other
Enumeration date
04/02/2016
Last updated
04/02/2016
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