Provider Demographics
NPI:1083609234
Name:RELIEVA
Entity Type:Organization
Organization Name:RELIEVA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:DENNIS
Authorized Official - Middle Name:J
Authorized Official - Last Name:HAZLETT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:970-472-1072
Mailing Address - Street 1:4025 AUTOMATION WAY
Mailing Address - Street 2:B-1
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80525-3446
Mailing Address - Country:US
Mailing Address - Phone:970-472-1072
Mailing Address - Fax:970-472-1071
Practice Address - Street 1:4025 AUTOMATION WAY
Practice Address - Street 2:B-1
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80525-3446
Practice Address - Country:US
Practice Address - Phone:970-472-1072
Practice Address - Fax:970-472-1071
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO2335261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO802187Medicare UPIN