Provider Demographics
NPI:1679892475
Name:DELTA WAVES OF WOODLAND PARK INC
Entity Type:Organization
Organization Name:DELTA WAVES OF WOODLAND PARK INC
Other - Org Name:DELTA WAVES OF PUEBLO
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RANDALL
Authorized Official - Middle Name:LOWELL
Authorized Official - Last Name:ANDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:719-262-9283
Mailing Address - Street 1:5835 LEHMAN DR
Mailing Address - Street 2:STE. 101
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80918-3408
Mailing Address - Country:US
Mailing Address - Phone:719-262-9283
Mailing Address - Fax:719-262-9285
Practice Address - Street 1:3921 OUTLOOK BLVD
Practice Address - Street 2:STE D
Practice Address - City:PUEBLO
Practice Address - State:CO
Practice Address - Zip Code:81008-1580
Practice Address - Country:US
Practice Address - Phone:719-583-9283
Practice Address - Fax:719-583-9285
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-19
Last Update Date:2010-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS1200XAmbulatory Health Care FacilitiesClinic/CenterSleep Disorder Diagnostic