1295900348 NPI number — CARE SUPPORT, INC.

Table of content: (NPI 1295900348)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1295900348 NPI number — CARE SUPPORT, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CARE SUPPORT, INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1295900348
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/29/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2835 PATTERSON RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GRAND JUNCTION
Provider Business Mailing Address State Name:
CO
Provider Business Mailing Address Postal Code:
81506-6066
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
970-243-7224
Provider Business Mailing Address Fax Number:
970-243-0533

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2835 PATTERSON RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GRAND JUNCTION
Provider Business Practice Location Address State Name:
CO
Provider Business Practice Location Address Postal Code:
81506-6066
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
970-243-7224
Provider Business Practice Location Address Fax Number:
970-243-0533
Provider Enumeration Date:
04/29/2008

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
AVERY
Authorized Official First Name:
ROBIN
Authorized Official Middle Name:
Authorized Official Title or Position:
EXECUTIVE DIRECTOR
Authorized Official Telephone Number:
970-243-7224

Provider Taxonomy Codes

  • Taxonomy code: 310400000X , with the licence number:  2311QD , registered in the state of CO ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 310400000X , with the licence number: 23114D , registered in the state of CO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 29138515 , issued by the state of ( CO ) . This identifiers is of the category "MEDICAID".
  • Identifier: 09951024 , issued by the state of ( CO ) . This identifiers is of the category "MEDICAID".