1366536054 NPI number — BT PROFESSIONAL CARE SERVICES, LLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1366536054 NPI number — BT PROFESSIONAL CARE SERVICES, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BT PROFESSIONAL CARE SERVICES, LLC
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:
6
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:
1366536054
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/16/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
12000 WASHINGTON ST
Provider Second Line Business Mailing Address:
STE 325
Provider Business Mailing Address City Name:
THORNTON
Provider Business Mailing Address State Name:
CO
Provider Business Mailing Address Postal Code:
80241-3155
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
303-619-0927
Provider Business Mailing Address Fax Number:
303-759-3949

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
12000 WASHINGTON ST
Provider Second Line Business Practice Location Address:
STE 325
Provider Business Practice Location Address City Name:
THORNTON
Provider Business Practice Location Address State Name:
CO
Provider Business Practice Location Address Postal Code:
80241-3155
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
303-619-0927
Provider Business Practice Location Address Fax Number:
303-759-3949
Provider Enumeration Date:
10/03/2006

Additional Information

Authorized Official

Authorized Official Last Name:
MCCUBBIN
Authorized Official First Name:
BARBARA
Authorized Official Middle Name:
TYNDALL
Authorized Official Title or Position:
OFFICER
Authorized Official Telephone Number:
303-619-0927

Provider Taxonomy Codes

  • Taxonomy code: 101YM0800X , with the licence number:  4070 , 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)





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