Individual
JUSTIN BENNETT WILEY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
3113 TELLER ST, WHEAT RIDGE, CO 80033-8057
(303) 233-2808
Mailing address
3113 TELLER ST, WHEAT RIDGE, CO 80033-8057
(303) 233-2808
Taxonomy
Speciality
Code
Description
License number
State
310400000X
Assisted Living Facility
Primary
230414
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
230414
—
CO
Enumeration date
09/07/2018
Last updated
09/19/2018
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