Provider Demographics
NPI:1962774877
Name:CONTINENCE CENTER OF NORTHERN COLORADO
Entity type:Organization
Organization Name:CONTINENCE CENTER OF NORTHERN COLORADO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PROVIDER
Authorized Official - Prefix:MRS
Authorized Official - First Name:LISA
Authorized Official - Middle Name:W
Authorized Official - Last Name:MYERS
Authorized Official - Suffix:
Authorized Official - Credentials:NP-C
Authorized Official - Phone:970-430-0555
Mailing Address - Street 1:1721 W HARMONY ROAD
Mailing Address - Street 2:SUITE 102
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80526-7611
Mailing Address - Country:US
Mailing Address - Phone:970-430-0555
Mailing Address - Fax:970-674-7945
Practice Address - Street 1:1721 W HARMONY RD
Practice Address - Street 2:SUITE 102
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80526-7610
Practice Address - Country:US
Practice Address - Phone:970-430-0555
Practice Address - Fax:970-674-7945
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-08
Last Update Date:2012-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO5583261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center