1770861817 NPI number — MANUEL ENTERPRISES INC

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 1770861817 NPI number — MANUEL ENTERPRISES INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MANUEL ENTERPRISES 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:
NEPENTHE HOME MEDICAL EQUIPMENT
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:
1770861817
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/22/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1969 W UINTAH ST
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:
80904-2739
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
719-633-4400
Provider Business Mailing Address Fax Number:
719-633-0603

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
16222 W US HIGHWAY 24
Provider Second Line Business Practice Location Address:
SUITE 130
Provider Business Practice Location Address City Name:
WOODLAND PARK
Provider Business Practice Location Address State Name:
CO
Provider Business Practice Location Address Postal Code:
80863-8762
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
719-686-7500
Provider Business Practice Location Address Fax Number:
719-686-7590
Provider Enumeration Date:
07/22/2011

Additional Information

Authorized Official

Authorized Official Last Name:
FINNEY
Authorized Official First Name:
SUSAN
Authorized Official Middle Name:
LYNN
Authorized Official Title or Position:
OFFICE MANAGER
Authorized Official Telephone Number:
719-633-4400

Provider Taxonomy Codes

  • Taxonomy code: 332BX2000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 08012486 , issued by the state of ( CO ) . This identifiers is of the category "MEDICAID".




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