Organization
SAMPLE SUPPORTS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CARMEN SAMPLE (CEO)
(720) 684-6102
Entity
Organization
Contact information
Practice address
1528 N LINCOLN AVE, UNIT 2, LOVELAND, CO 80538-3849
(720) 684-6102
Mailing address
1528 N LINCOLN AVE, UNIT 2, LOVELAND, CO 80538-3849
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
40078256
—
CO
Enumeration date
02/04/2016
Last updated
02/04/2016
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