1063877306 NPI number — ELEPHANT IN THE ROOM LLC

Table of content: (NPI 1063877306)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1063877306 NPI number — ELEPHANT IN THE ROOM LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ELEPHANT IN THE ROOM 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:
ELEPHANT IN THE ROOM LLC
Provider Other Organization Name Type Code:
5
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:
1063877306
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/15/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7596 W JEWELL AVE # 1-202
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LAKEWOOD
Provider Business Mailing Address State Name:
CO
Provider Business Mailing Address Postal Code:
80232-6889
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
720-310-6713
Provider Business Mailing Address Fax Number:
844-412-7875

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7596 W JEWELL AVE # 1-202
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LAKEWOOD
Provider Business Practice Location Address State Name:
CO
Provider Business Practice Location Address Postal Code:
80232-6889
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
720-310-6713
Provider Business Practice Location Address Fax Number:
844-412-7875
Provider Enumeration Date:
12/30/2015

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
ORTIZ
Authorized Official First Name:
ZINA
Authorized Official Middle Name:
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
720-310-6710

Provider Taxonomy Codes

  • Taxonomy code: 101YP2500X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 98870076 , issued by the state of ( CO ) . This identifiers is of the category "MEDICAID".
  • Identifier: 17687543 , issued by the state of ( CO ) . This identifiers is of the category "MEDICAID".