1629252952 NPI number — GROWING EXPERIENTIALLY MULTI-DISCIPLINARY SERVICE

Table of content: RACHAEL MARIE BOGUMIL LMT (NPI 1932363348)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1629252952 NPI number — GROWING EXPERIENTIALLY MULTI-DISCIPLINARY SERVICE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
GROWING EXPERIENTIALLY MULTI-DISCIPLINARY SERVICE
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:
1629252952
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/21/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3443 S GALENA ST
Provider Second Line Business Mailing Address:
STE. 255
Provider Business Mailing Address City Name:
DENVER
Provider Business Mailing Address State Name:
CO
Provider Business Mailing Address Postal Code:
80231-5079
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
303-752-2977
Provider Business Mailing Address Fax Number:
303-752-2971

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3443 S GALENA ST
Provider Second Line Business Practice Location Address:
STE. 255
Provider Business Practice Location Address City Name:
DENVER
Provider Business Practice Location Address State Name:
CO
Provider Business Practice Location Address Postal Code:
80231-5079
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
303-752-2977
Provider Business Practice Location Address Fax Number:
303-752-2971
Provider Enumeration Date:
12/21/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
VADELIUS
Authorized Official First Name:
KENT
Authorized Official Middle Name:
Authorized Official Title or Position:
OFFICE MANAGER
Authorized Official Telephone Number:
303-752-2977

Provider Taxonomy Codes

  • Taxonomy code: 235Z00000X , registered in the state of CO ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QX0100X , registered in the state of CO ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QM1300X , 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)