Provider Demographics
NPI:1225225600
Name:HEALTH ELECTIVES AND LIFE OPTIONS
Entity Type:Organization
Organization Name:HEALTH ELECTIVES AND LIFE OPTIONS
Other - Org Name:HEALTH ELECTIVES AND LIFE OPTIONS
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:MD/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LEONARD
Authorized Official - Middle Name:W
Authorized Official - Last Name:CAIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:970-564-8177
Mailing Address - Street 1:321 E NORTH ST
Mailing Address - Street 2:
Mailing Address - City:CORTEZ
Mailing Address - State:CO
Mailing Address - Zip Code:81321-3230
Mailing Address - Country:US
Mailing Address - Phone:970-564-8177
Mailing Address - Fax:970-564-8179
Practice Address - Street 1:321 E NORTH ST
Practice Address - Street 2:
Practice Address - City:CORTEZ
Practice Address - State:CO
Practice Address - Zip Code:81321-3230
Practice Address - Country:US
Practice Address - Phone:970-564-8177
Practice Address - Fax:970-564-8179
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-28
Last Update Date:2009-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO01276815Medicaid
CO460988Medicare PIN