Provider Demographics
NPI:1447395900
Name:ADVANCED SPINAL REAHB OF GRAND JUNCTION LLC
Entity Type:Organization
Organization Name:ADVANCED SPINAL REAHB OF GRAND JUNCTION LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:J
Authorized Official - Last Name:ANGELLO
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:970-248-9833
Mailing Address - Street 1:2352 N 7TH ST
Mailing Address - Street 2:SUITE C
Mailing Address - City:GRAND JUNCTION
Mailing Address - State:CO
Mailing Address - Zip Code:81501-8168
Mailing Address - Country:US
Mailing Address - Phone:970-248-9833
Mailing Address - Fax:970-248-9833
Practice Address - Street 1:2352 N 7TH ST
Practice Address - Street 2:SUITE C
Practice Address - City:GRAND JUNCTION
Practice Address - State:CO
Practice Address - Zip Code:81501-8168
Practice Address - Country:US
Practice Address - Phone:970-248-9833
Practice Address - Fax:970-248-9833
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization