1194694307 NPI number — REACH HIGHER ABA COLORADO, 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 1194694307 NPI number — REACH HIGHER ABA COLORADO, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
REACH HIGHER ABA COLORADO, 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:
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:
1194694307
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/16/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
700 ROCKAWAY TPKE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LAWRENCE
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11559-1014
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
917-397-3565
Provider Business Mailing Address Fax Number:
917-397-3565

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
310 MARKET ST STE 100
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BASALT
Provider Business Practice Location Address State Name:
CO
Provider Business Practice Location Address Postal Code:
81621-7401
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
917-423-6997
Provider Business Practice Location Address Fax Number:
917-423-6997
Provider Enumeration Date:
11/04/2025

Additional Information

Authorized Official

Authorized Official Last Name:
GALEN
Authorized Official First Name:
YOSEF
Authorized Official Middle Name:
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
215-970-3444

Provider Taxonomy Codes

  • Taxonomy code: 103K00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 251S00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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