Provider Demographics
NPI:1871259259
Name:UDOLIE CORP
Entity type:Organization
Organization Name:UDOLIE CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ BRANCH MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:STACIE
Authorized Official - Middle Name:
Authorized Official - Last Name:JEFFERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:970-628-1241
Mailing Address - Street 1:715 HORIZON DR STE 300
Mailing Address - Street 2:
Mailing Address - City:GRAND JUNCTION
Mailing Address - State:CO
Mailing Address - Zip Code:81506-8727
Mailing Address - Country:US
Mailing Address - Phone:970-628-1241
Mailing Address - Fax:
Practice Address - Street 1:715 HORIZON DR STE 300
Practice Address - Street 2:
Practice Address - City:GRAND JUNCTION
Practice Address - State:CO
Practice Address - Zip Code:81506-8727
Practice Address - Country:US
Practice Address - Phone:970-628-1241
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-11-10
Last Update Date:2021-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health