Provider Demographics
NPI:1861619850
Name:CHARBAR INC
Entity type:Organization
Organization Name:CHARBAR INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BARBARA
Authorized Official - Middle Name:KAY
Authorized Official - Last Name:MAZZELLA
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:970-270-4158
Mailing Address - Street 1:1402 HOWARD STREET
Mailing Address - Street 2:
Mailing Address - City:DELTA
Mailing Address - State:CO
Mailing Address - Zip Code:81416
Mailing Address - Country:US
Mailing Address - Phone:970-874-4195
Mailing Address - Fax:970-874-4892
Practice Address - Street 1:1402 HOWARD STREET
Practice Address - Street 2:
Practice Address - City:DELTA
Practice Address - State:CO
Practice Address - Zip Code:81416
Practice Address - Country:US
Practice Address - Phone:970-874-4195
Practice Address - Fax:970-874-4892
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-19
Last Update Date:2016-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO00027758Medicaid