1114584232 NPI number — SCW RECOVERY LLC

Table of content: (NPI 1114584232)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1114584232 NPI number — SCW RECOVERY LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SCW RECOVERY 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:
6
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:
1114584232
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/19/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3801 E FLORIDA AVE STE 650
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:
80210-2562
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
888-233-1553
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
330 FIEDLER AVE
Provider Second Line Business Practice Location Address:
STE 103
Provider Business Practice Location Address City Name:
DILLON
Provider Business Practice Location Address State Name:
CO
Provider Business Practice Location Address Postal Code:
80435
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
888-233-1553
Provider Business Practice Location Address Fax Number:
720-282-5737
Provider Enumeration Date:
05/23/2019

Additional Information

Authorized Official

Authorized Official Last Name:
CHERAMY
Authorized Official First Name:
DONNA
Authorized Official Middle Name:
Authorized Official Title or Position:
EXECUTIVE DIRECTOR
Authorized Official Telephone Number:
928-899-5828

Provider Taxonomy Codes

  • Taxonomy code: 324500000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1832-01 . This is a "OBH LICENSE NUMBER" identifier , issued by the state of ( CO ) . This identifiers is of the category "OTHER".




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