1063401420 NPI number — GUNERATNE LLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1063401420 NPI number — GUNERATNE LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
GUNERATNE LLC
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:
LIFESPRING HOME CARE
Provider Other Organization Name Type Code:
3
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:
1063401420
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/25/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
312 WILCOX ST
Provider Second Line Business Mailing Address:
#204
Provider Business Mailing Address City Name:
CASTLE ROCK
Provider Business Mailing Address State Name:
CO
Provider Business Mailing Address Postal Code:
80104-2480
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
303-663-3663
Provider Business Mailing Address Fax Number:
303-663-8879

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
312 WILCOX ST
Provider Second Line Business Practice Location Address:
#204
Provider Business Practice Location Address City Name:
CASTLE ROCK
Provider Business Practice Location Address State Name:
CO
Provider Business Practice Location Address Postal Code:
80104-2480
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
303-663-3663
Provider Business Practice Location Address Fax Number:
303-663-8879
Provider Enumeration Date:
10/18/2005

Additional Information

Authorized Official

Authorized Official Last Name:
GUNERATNE
Authorized Official First Name:
PRASSANA
Authorized Official Middle Name:
Authorized Official Title or Position:
ADMINISTRATOR
Authorized Official Telephone Number:
303-663-3663

Provider Taxonomy Codes

  • Taxonomy code: 251E00000X , with the licence number:  N/A , 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)

  • Identifier: 67732739 , issued by the state of ( CO ) . This identifiers is of the category "MEDICAID".
  • Identifier: 841591880 . This is a "UNITED HEALTH CARE #" identifier , issued by the state of ( CO ) . This identifiers is of the category "OTHER".
  • Identifier: 841591880-01 . This is a "PACIFICARE/SECURE HORIZON" identifier , issued by the state of ( CO ) . This identifiers is of the category "OTHER".
  • Identifier: 606739000 . This is a "ACS-DEPARTMENT OF LABOR" identifier , issued by the state of ( CO ) . This identifiers is of the category "OTHER".




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