1912444993 NPI number — ST.ANTHONY OF PADUA HOMES, LLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1912444993 NPI number — ST.ANTHONY OF PADUA HOMES, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ST.ANTHONY OF PADUA HOMES, 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:
1912444993
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/27/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
14024 PARK COVE DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BROOMFIELD
Provider Business Mailing Address State Name:
CO
Provider Business Mailing Address Postal Code:
80023-6596
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3545 LEYDEN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DENVER
Provider Business Practice Location Address State Name:
CO
Provider Business Practice Location Address Postal Code:
80207-1343
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
303-333-0305
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/27/2017

Additional Information

Authorized Official

Authorized Official Last Name:
BOUTROUS
Authorized Official First Name:
MARIA
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
701-226-0905

Provider Taxonomy Codes

  • Taxonomy code: 310400000X , with the licence number:  23O672 , 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)





Copyright © 2007-2025 www.npivalidator.com