1336428630 NPI number — GOLDLEAF CAREGIVERS INC.

Table of content: (NPI 1336428630)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1336428630 NPI number — GOLDLEAF CAREGIVERS INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
GOLDLEAF CAREGIVERS INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1336428630
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/04/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1780 S BELLAIRE ST
Provider Second Line Business Mailing Address:
SUITE 701
Provider Business Mailing Address City Name:
DENVER
Provider Business Mailing Address State Name:
CO
Provider Business Mailing Address Postal Code:
80222-4307
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
720-763-9039
Provider Business Mailing Address Fax Number:
720-763-9036

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1780 S BELLAIRE ST
Provider Second Line Business Practice Location Address:
SUITE 701
Provider Business Practice Location Address City Name:
DENVER
Provider Business Practice Location Address State Name:
CO
Provider Business Practice Location Address Postal Code:
80222-4307
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
720-763-9039
Provider Business Practice Location Address Fax Number:
720-763-9036
Provider Enumeration Date:
08/04/2011

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
RHODES
Authorized Official First Name:
LIA
Authorized Official Middle Name:
Authorized Official Title or Position:
COO & OWNER
Authorized Official Telephone Number:
720-763-9039

Provider Taxonomy Codes

  • Taxonomy code: 253Z00000X , with the licence number:  04O232 , registered in the state of CO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)