| Extreme Sports Camp | |
|
23286 Two Rivers Rd Suite 24-a Basalt CO 81621-9285 | |
| (970) 927-3143 | |
| Not Available |
| Full Name | Extreme Sports Camp |
|---|---|
| Speciality | Counselor |
| Location | 23286 Two Rivers Rd, Basalt, Colorado |
| Authorized Official Name and Position | Sallie Bernard (EXECUTIVE DIRECTOR) |
| Authorized Official Contact | 9709270433 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Extreme Sports Camp 23286 Two Rivers Rd Suite 24-a Basalt CO 81621-9285 Ph: (970) 927-3143 | Extreme Sports Camp 23286 Two Rivers Rd Suite 24-a Basalt CO 81621-9285 Ph: (970) 927-3143 |
| NPI Number | 1669744637 |
|---|---|
| Provider Enumeration Date | 02/06/2012 |
| Last Update Date | 02/06/2012 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1669744637 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101Y00000X | Counselor | 1534517 (Colorado) | Primary |
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