| NPI | 1275071268 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 251C00000X (Licence: CO 36358851) |
| Additional Taxonomies | 320900000X Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities (Licence: CO 36358851) |
| 343900000X Non-emergency Medical Transport (VAN) (Licence: CO 36358851) | |
| 373H00000X Day Training/Habilitation Specialist (Licence: CO 36358851) | |
| 376J00000X Homemaker (Licence: CO 36358851) | |
| 385HR2060X Respite Care, Respite Care, Intellectual and/or Developmental Disabilities, Child (Licence: CO 36358851) | |
| Enumeration Date | 2017-02-09 |
| Last Update Date | 2020-01-07 |