Provider Demographics
NPI:1922545623
Name:MEREDTIH, CAROL
Entity Type:Individual
Prefix:
First Name:CAROL
Middle Name:
Last Name:MEREDTIH
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 1:7228 S GORE RANGE RD
Mailing Address - Street 2:
Mailing Address - City:LITTLETON
Mailing Address - State:CO
Mailing Address - Zip Code:80127-3229
Mailing Address - Country:US
Mailing Address - Phone:303-507-7564
Mailing Address - Fax:303-220-0994
Practice Address - Street 1:7369 S ALKIRE ST
Practice Address - Street 2:204
Practice Address - City:LITTLETON
Practice Address - State:CO
Practice Address - Zip Code:80127-7532
Practice Address - Country:US
Practice Address - Phone:303-507-7564
Practice Address - Fax:303-220-9228
Is Sole Proprietor?:No
Enumeration Date:2017-01-20
Last Update Date:2017-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO372500000X, 372600000X, 373H00000X, 374U00000X, 376J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes373H00000XNursing Service Related ProvidersDay Training/Habilitation Specialist
No372500000XNursing Service Related ProvidersChore Provider
No372600000XNursing Service Related ProvidersAdult Companion
No374U00000XNursing Service Related ProvidersHome Health Aide
No376J00000XNursing Service Related ProvidersHomemaker
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO76685772Medicaid