Basic Information
| Provider Information | |||||||||
| NPI: | 1497779094 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | HEALTHONE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3444 S EMERSON ST | ||||||||
| Address2: | |||||||||
| City: | ENGLEWOOD | ||||||||
| State: | CO | ||||||||
| PostalCode: | 801132834 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3037891519 | ||||||||
| FaxNumber: | 3037897642 | ||||||||
| Practice Location | |||||||||
| Address1: | 3444 S EMERSON ST | ||||||||
| Address2: | |||||||||
| City: | ENGLEWOOD | ||||||||
| State: | CO | ||||||||
| PostalCode: | 801132834 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3037891519 | ||||||||
| FaxNumber: | 3037897642 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/27/2006 | ||||||||
| LastUpdateDate: | 06/19/2008 | ||||||||
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| AuthorizedOfficialLastName: | TYSSELAND | ||||||||
| AuthorizedOfficialFirstName: | CAROLINE | ||||||||
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| AuthorizedOfficialTitleorPosition: | PROGRAM DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 3037891519 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MS. | ||||||||
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| AuthorizedOfficialCredential: | BS, RN | ||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 385H00000X | NOT REQUIRED | CO | Y | Respite Care Facility | Respite Care |
No ID Information.