1427053230 NPI number — WELLNESS WAY INC

Table of content: (NPI 1427053230)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1427053230 NPI number — WELLNESS WAY INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
WELLNESS WAY 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:
AMI-WELLNESS HOME HEALTH
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:
1427053230
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/12/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1385 S COLORADO BLVD
Provider Second Line Business Mailing Address:
STE 306
Provider Business Mailing Address City Name:
DENVER
Provider Business Mailing Address State Name:
CO
Provider Business Mailing Address Postal Code:
80222-3304
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
303-722-2208
Provider Business Mailing Address Fax Number:
303-722-4411

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1385 S COLORADO BLVD STE 306
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DENVER
Provider Business Practice Location Address State Name:
CO
Provider Business Practice Location Address Postal Code:
80222-3365
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
303-722-2208
Provider Business Practice Location Address Fax Number:
303-722-4411
Provider Enumeration Date:
06/17/2005

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
MAESTAS
Authorized Official First Name:
CHRISTOPHER
Authorized Official Middle Name:
M
Authorized Official Title or Position:
GEN MGR
Authorized Official Telephone Number:
303-722-2208

Provider Taxonomy Codes

  • Taxonomy code: 251E00000X , with the licence number:  0404MV , 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: 116942400 , issued by the state of ( WY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 6553X . This is a "PACIFICARE" identifier , issued by the state of ( CO ) . This identifiers is of the category "OTHER".
  • Identifier: 05701354 , issued by the state of ( CO ) . This identifiers is of the category "MEDICAID".
  • Identifier: 17822050 , issued by the state of ( CO ) . This identifiers is of the category "MEDICAID".
  • Identifier: 00754WE . This is a "BCBS" identifier , issued by the state of ( CO ) . This identifiers is of the category "OTHER".