Provider Demographics
NPI:1801395645
Name:GROSS, LOIS
Entity Type:Individual
Prefix:
First Name:LOIS
Middle Name:
Last Name:GROSS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4660 COUNTY ROAD 311
Mailing Address - Street 2:
Mailing Address - City:NEW CASTLE
Mailing Address - State:CO
Mailing Address - Zip Code:81647-9621
Mailing Address - Country:US
Mailing Address - Phone:970-876-2047
Mailing Address - Fax:970-876-0550
Practice Address - Street 1:4660 COUNTY ROAD 311
Practice Address - Street 2:
Practice Address - City:NEW CASTLE
Practice Address - State:CO
Practice Address - Zip Code:81647-9621
Practice Address - Country:US
Practice Address - Phone:970-876-2047
Practice Address - Fax:970-876-0550
Is Sole Proprietor?:Yes
Enumeration Date:2018-02-07
Last Update Date:2018-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO171WH0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171WH0202XOther Service ProvidersContractorHome Modifications