1821681396 NPI number — FRIENDS WITH DISABILITIES LLC

Table of content: (NPI 1821681396)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1821681396 NPI number — FRIENDS WITH DISABILITIES LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
FRIENDS WITH DISABILITIES 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:
1821681396
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/02/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
13900 E FLORIDA AVE STE D
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
AURORA
Provider Business Mailing Address State Name:
CO
Provider Business Mailing Address Postal Code:
80012-5821
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
720-324-8939
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
13900 E FLORIDA AVE STE D
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:
80012-5821
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
720-324-8939
Provider Business Practice Location Address Fax Number:
855-730-1611
Provider Enumeration Date:
02/16/2021

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
MOORE
Authorized Official First Name:
NANCY
Authorized Official Middle Name:
R
Authorized Official Title or Position:
EXECUTIVE VP OF OPERATIONS
Authorized Official Telephone Number:
720-324-8939

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 332BC3200X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 9000194845 , issued by the state of ( CO ) . This identifiers is of the category "MEDICAID".
  • Identifier: 20216000369 . This is a "DME SUPPLIER LICENSE" identifier , issued by the state of ( CO ) . This identifiers is of the category "OTHER".