Organization Name: | REHAB COLORADO LLC |
NPI Number: | 1124362918 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | MICHAEL E. TARVIN (VICE PRESIDENT) |
Mailing Address: | 555 S Park Ave Plaza 2 Breckenridge |
State: | CO US |
Postal Code: | 80424 |
Phone Number: | 9704010175 |
Fax Number: | 9704537972 |
NPI Enumeration Date: | 11/16/2012 |
NPI Last Update Date: | 05/05/2016 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 261QR0400X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | CO |
Taxonomy Type: | Ambulatory Health Care Facilities |
Taxonomy Classification: | Clinic/Center |
Taxonomy Specialization: | Rehabilitation |
Taxonomy Definition: |