Provider Demographics
NPI:1396026407
Name:CAROLYN DACRES, RXS, LLC
Entity Type:Organization
Organization Name:CAROLYN DACRES, RXS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE PROPRIETOR
Authorized Official - Prefix:
Authorized Official - First Name:CAROLYN
Authorized Official - Middle Name:
Authorized Official - Last Name:DACRES
Authorized Official - Suffix:
Authorized Official - Credentials:RXS, CNS
Authorized Official - Phone:303-355-0803
Mailing Address - Street 1:4155 E JEWELL AVE STE 225
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80222-4506
Mailing Address - Country:US
Mailing Address - Phone:303-355-0803
Mailing Address - Fax:888-692-9168
Practice Address - Street 1:4155 E JEWELL AVE STE 225
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80222-4506
Practice Address - Country:US
Practice Address - Phone:303-355-0803
Practice Address - Fax:888-692-9168
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-09-01
Last Update Date:2011-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CORXS 1451364SP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes364SP0808XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental HealthGroup - Single Specialty