Extreme Sports Camp
Organization Active NPI Counselor · Basalt, CO
NPI 1669744637 · NPPES record last updated Feb 6, 2012
Key facts
- NPI
- 1669744637
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Counselor 101Y00000X
- License
- 1534517 (CO)
- Legal business name
- EXTREME SPORTS CAMP
- Practice address
- 23286 Two Rivers Rd
Suite 24-a
Basalt, CO 81621-9285 - Phone
- (970) 927-3143
- NPI assigned
- Feb 6, 2012
- Organization subpart
- No
Authorized official
- Name
- Mrs. Sallie Bernard
- Title
- Executive Director
- Phone
- (970) 927-0433
Corporate family (same tax ID) 2
National Provider Directory
- Tax ID family
- Ascendigo Autism Services Inc
Locations
23286 Two Rivers Rd
Ste 24A
Basalt, CO 81621
Phone (970) 927-3143
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Counselor |
101Y00000X | 1534517 | CO | Yes |
Addresses
Primary practice location
23286 Two Rivers Rd
Suite 24-a
Basalt, CO 81621-9285
Mailing address
23286 Two Rivers Rd
Suite 24-a
Basalt, CO 81621-9285
Phone (970) 927-3143
Other providers in Basalt, CO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Feb 6, 2012. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.