Provider Demographics
NPI:1467571406
Name:COLORADO HEALTHCARE SUPPORT, INC DBA PARKER & CASTLE ROCK CENTER FOR A
Entity Type:Organization
Organization Name:COLORADO HEALTHCARE SUPPORT, INC DBA PARKER & CASTLE ROCK CENTER FOR A
Other - Org Name:CASTLE ROCK CENTER FOR AUDIOLOGY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:D
Authorized Official - Last Name:BAKER
Authorized Official - Suffix:
Authorized Official - Credentials:AUD
Authorized Official - Phone:303-841-8818
Mailing Address - Street 1:62 FOUNDERS PKWY
Mailing Address - Street 2:STE C-2
Mailing Address - City:CASTLE ROCK
Mailing Address - State:CO
Mailing Address - Zip Code:80104
Mailing Address - Country:US
Mailing Address - Phone:303-814-1725
Mailing Address - Fax:303-814-9594
Practice Address - Street 1:11211 S DRANSFELDT RD
Practice Address - Street 2:STE 133
Practice Address - City:PARKER
Practice Address - State:CO
Practice Address - Zip Code:80134
Practice Address - Country:US
Practice Address - Phone:303-841-8818
Practice Address - Fax:303-841-5088
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-29
Last Update Date:2014-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO104118231H00000X
COAUD72231H00000X, 237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologistGroup - Single Specialty
No237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid FitterGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
COCOB4839Medicare UPIN