1215937149 NPI number — BETHESDA HOME RESPIRATORY SERVICES

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 1215937149 NPI number — BETHESDA HOME RESPIRATORY SERVICES

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BETHESDA HOME RESPIRATORY SERVICES
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:
1215937149
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/17/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
9320 INGALLS ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WESTMINSTER
Provider Business Mailing Address State Name:
CO
Provider Business Mailing Address Postal Code:
80031-2822
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
303-657-1434
Provider Business Mailing Address Fax Number:
303-657-3313

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
105 S SUNSET ST STE B
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LONGMONT
Provider Business Practice Location Address State Name:
CO
Provider Business Practice Location Address Postal Code:
80501-6172
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
303-657-1434
Provider Business Practice Location Address Fax Number:
303-657-3313
Provider Enumeration Date:
07/21/2005

Additional Information

Authorized Official

Authorized Official Last Name:
RAPP
Authorized Official First Name:
ROSE
Authorized Official Middle Name:
M
Authorized Official Title or Position:
OWNER AND VP
Authorized Official Telephone Number:
303-657-1434

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X , with the licence number:  2254701 , 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: 53852885 , issued by the state of ( CO ) . This identifiers is of the category "MEDICAID".




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