1831149962 NPI number — 656 DILLON WAY OPERATIONS LLC

Table of content: (NPI 1831149962)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1831149962 NPI number — 656 DILLON WAY OPERATIONS LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
656 DILLON WAY OPERATIONS 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:
ASPEN CENTER
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:
1831149962
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/21/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
101 E STATE ST
Provider Second Line Business Mailing Address:
REIMBURSEMENT
Provider Business Mailing Address City Name:
KENNETT SQUARE
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
19348-3109
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
505-468-4742
Provider Business Mailing Address Fax Number:
505-468-8742

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
656 DILLON WAY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
AURORA
Provider Business Practice Location Address State Name:
CO
Provider Business Practice Location Address Postal Code:
80011-6803
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
303-344-0636
Provider Business Practice Location Address Fax Number:
303-344-0639
Provider Enumeration Date:
05/11/2006

Additional Information

Authorized Official

Authorized Official Last Name:
DIVITTORIO
Authorized Official First Name:
THOMAS
Authorized Official Middle Name:
Authorized Official Title or Position:
CFO, TREASURER, ASST SECRETARY
Authorized Official Telephone Number:
610-444-6350

Provider Taxonomy Codes

  • Taxonomy code: 314000000X , with the licence number:  0389 , registered in the state of CO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 385H00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 05652953 , issued by the state of ( CO ) . This identifiers is of the category "MEDICAID".
  • Identifier: 7100495 . This is a "EVERCARE" identifier , issued by the state of ( CO ) . This identifiers is of the category "OTHER".
  • Identifier: 522089013 . This is a "COLORADO ACCESS" identifier , issued by the state of ( CO ) . This identifiers is of the category "OTHER".




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