Allen Joel Hackett

Individual provider Active NPI Home Modifications Contractor · Dolores, CO

NPI 1255992103 · NPPES record last updated Jun 21, 2019

Key facts

NPI
1255992103
Entity type
Individual (NPI type 1)
Primary specialty
Home Modifications Contractor 171WH0202X
Practice address
18664 Road 22.6
Dolores, CO 81323-8603
Phone
(970) 529-6930
NPI assigned
Jun 21, 2019
Sex
Male
Sole proprietor
Yes

Medicare participation

Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD)
No

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Home Modifications Contractor 171WH0202X Yes

Addresses

Primary practice location

18664 Road 22.6
Dolores, CO 81323-8603

Mailing address

18664 Road 22.6
Dolores, CO 81323-8603
Phone (970) 529-6930

Other providers in Dolores, CO

All providers in Dolores, CO · Home Modifications Contractor in Colorado

Sources for this page

Verify at the official NPI Registry.