1528510401 NPI number — COMMUNITY OPTIONS, INC.

Table of content: (NPI 1528510401)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1528510401 NPI number — COMMUNITY OPTIONS, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
COMMUNITY OPTIONS, 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:
1528510401
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/25/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 31
Provider Second Line Business Mailing Address:
336 S. 10TH ST.
Provider Business Mailing Address City Name:
MONTROSE
Provider Business Mailing Address State Name:
CO
Provider Business Mailing Address Postal Code:
81402-0031
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
61257 POPULAR RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MONTROSE
Provider Business Practice Location Address State Name:
CO
Provider Business Practice Location Address Postal Code:
81403-9665
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
970-249-1412
Provider Business Practice Location Address Fax Number:
970-249-0245
Provider Enumeration Date:
10/26/2016

Additional Information

Authorized Official

Authorized Official Last Name:
TEA
Authorized Official First Name:
HOLLY
Authorized Official Middle Name:
S
Authorized Official Title or Position:
IT DIRECTOR
Authorized Official Telephone Number:
970-249-1412

Provider Taxonomy Codes

  • Taxonomy code: 320900000X , with the licence number:  05B950 , 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: 130466 . This is a "COLORADO INTERCHANGE PROVIDER" identifier , issued by the state of ( CO ) . This identifiers is of the category "OTHER".




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