Provider Demographics
NPI:1255788402
Name:COLORADO LIONS CAMP INC
Entity type:Organization
Organization Name:COLORADO LIONS CAMP INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:SHARRON
Authorized Official - Middle Name:
Authorized Official - Last Name:NICKERSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:719-687-2087
Mailing Address - Street 1:PO BOX 9043
Mailing Address - Street 2:
Mailing Address - City:WOODLAND PARK
Mailing Address - State:CO
Mailing Address - Zip Code:80863-0240
Mailing Address - Country:US
Mailing Address - Phone:719-687-2087
Mailing Address - Fax:719-687-7435
Practice Address - Street 1:28541 HIGHWAY 67
Practice Address - Street 2:
Practice Address - City:WOOODAND PARK
Practice Address - State:CO
Practice Address - Zip Code:80863
Practice Address - Country:US
Practice Address - Phone:719-687-2087
Practice Address - Fax:719-687-7435
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-18
Last Update Date:2016-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COR47606385HR2050X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes385HR2050XRespite Care FacilityRespite CareRespite Care Camp