Provider Demographics
NPI:1366125841
Name:BYKOTA WESLO
Entity type:Organization
Organization Name:BYKOTA WESLO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTION
Authorized Official - Prefix:MRS
Authorized Official - First Name:JEANNE
Authorized Official - Middle Name:R
Authorized Official - Last Name:HICKS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:970-254-8888
Mailing Address - Street 1:301 N PAGOSA BLVD
Mailing Address - Street 2:
Mailing Address - City:PAGOSA SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:81147-9465
Mailing Address - Country:US
Mailing Address - Phone:970-264-5991
Mailing Address - Fax:
Practice Address - Street 1:2809 BUNTING AVE
Practice Address - Street 2:
Practice Address - City:GRAND JUNCTION
Practice Address - State:CO
Practice Address - Zip Code:81501-6500
Practice Address - Country:US
Practice Address - Phone:970-254-8888
Practice Address - Fax:970-241-3021
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-08-10
Last Update Date:2023-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care