Provider Demographics
NPI:1629252952
Name:GROWING EXPERIENTIALLY MULTI-DISCIPLINARY SERVICE
Entity Type:Organization
Organization Name:GROWING EXPERIENTIALLY MULTI-DISCIPLINARY SERVICE
Other - Org Name:G.E.M.S.
Other - Org Type:Other Name
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KENT
Authorized Official - Middle Name:
Authorized Official - Last Name:VADELIUS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:303-752-2977
Mailing Address - Street 1:3443 S GALENA ST
Mailing Address - Street 2:STE. 255
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80231-5079
Mailing Address - Country:US
Mailing Address - Phone:303-752-2977
Mailing Address - Fax:303-752-2971
Practice Address - Street 1:3443 S GALENA ST
Practice Address - Street 2:STE. 255
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80231-5079
Practice Address - Country:US
Practice Address - Phone:303-752-2977
Practice Address - Fax:303-752-2971
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-21
Last Update Date:2007-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO235Z00000X, 261QM1300X, 261QX0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty
No261QX0100XAmbulatory Health Care FacilitiesClinic/CenterOccupational Medicine