Provider Demographics
NPI:1972808111
Name:M T WYANT ENTERPRISES INC.
Entity Type:Organization
Organization Name:M T WYANT ENTERPRISES INC.
Other - Org Name:COMFORCARE HOME SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:THERESA
Authorized Official - Middle Name:
Authorized Official - Last Name:WYANT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:970-229-0025
Mailing Address - Street 1:107 W 29TH ST STE 200
Mailing Address - Street 2:
Mailing Address - City:LOVELAND
Mailing Address - State:CO
Mailing Address - Zip Code:80538-2279
Mailing Address - Country:US
Mailing Address - Phone:970-229-0025
Mailing Address - Fax:
Practice Address - Street 1:107 W 29TH ST STE 200
Practice Address - Street 2:
Practice Address - City:LOVELAND
Practice Address - State:CO
Practice Address - Zip Code:80538-2279
Practice Address - Country:US
Practice Address - Phone:970-229-0025
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-19
Last Update Date:2011-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health