1356017099 NPI number — GREATER DENVER HOME HEALTH CARE INC

Table of content: DEVON BROOKE GUCKES MSED, ATC (NPI 1073801833)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1356017099 NPI number — GREATER DENVER HOME HEALTH CARE INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
GREATER DENVER HOME HEALTH CARE 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:
1356017099
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/23/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1582 S PARKER RD STE 306
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DENVER
Provider Business Mailing Address State Name:
CO
Provider Business Mailing Address Postal Code:
80231-2717
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
720-535-1504
Provider Business Mailing Address Fax Number:
303-353-8074

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1582 S PARKER RD STE 306
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DENVER
Provider Business Practice Location Address State Name:
CO
Provider Business Practice Location Address Postal Code:
80231-2717
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
720-535-1504
Provider Business Practice Location Address Fax Number:
303-353-8074
Provider Enumeration Date:
08/23/2021

Additional Information

Authorized Official

Authorized Official Last Name:
KAHIN
Authorized Official First Name:
AHMED
Authorized Official Middle Name:
RABI
Authorized Official Title or Position:
ADMINISTRATOR
Authorized Official Telephone Number:
720-535-1504

Provider Taxonomy Codes

  • Taxonomy code: 253Z00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 9000142622 , issued by the state of ( CO ) . This identifiers is of the category "MEDICAID".




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