Provider Demographics
NPI:1972900256
Name:MOSLEY, SHEILA SAM A (CACIII)
Entity Type:Individual
Prefix:
First Name:SHEILA SAM
Middle Name:A
Last Name:MOSLEY
Suffix:
Gender:F
Credentials:CACIII
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:266 QUARI STREET
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80011
Mailing Address - Country:US
Mailing Address - Phone:303-360-7163
Mailing Address - Fax:
Practice Address - Street 1:3874 W. PRINCETON CIRCLE
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80236
Practice Address - Country:US
Practice Address - Phone:720-283-3697
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-12-02
Last Update Date:2014-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1094-21324500000X
CO1488-01324500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility