1598992885 NPI number — LUCAS INC

Table of content: (NPI 1598992885)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1598992885 NPI number — LUCAS INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LUCAS 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:
PIKES PEAK RESPITE SERVICES
Provider Other Organization Name Type Code:
3
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:
1598992885
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/04/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5 PINE RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
COLORADO SPRINGS
Provider Business Mailing Address State Name:
CO
Provider Business Mailing Address Postal Code:
80906-4239
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
719-659-6344
Provider Business Mailing Address Fax Number:
720-836-4184

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5 PINE RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
COLORADO SPRINGS
Provider Business Practice Location Address State Name:
CO
Provider Business Practice Location Address Postal Code:
80906
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
719-659-6344
Provider Business Practice Location Address Fax Number:
720-836-4184
Provider Enumeration Date:
06/15/2009

Additional Information

Authorized Official

Authorized Official Last Name:
SEEMANN
Authorized Official First Name:
BEVERLY
Authorized Official Middle Name:
MAE
Authorized Official Title or Position:
CEO/EXECUTIVE DIRECTOR
Authorized Official Telephone Number:
719-659-6344

Provider Taxonomy Codes

  • Taxonomy code: 3747P1801X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 376J00000X , registered in the state of CO ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 385H00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 385HR2060X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 385HR2065X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

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




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