1922462654 NPI number — CAROLINE HUMBLES

Table of content: CAROLINE HUMBLES (NPI 1922462654)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1922462654 NPI number — CAROLINE HUMBLES

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HUMBLES
Provider First Name:
CAROLINE
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
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:
1922462654
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/04/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8950 E. LOWRY BLVD
Provider Second Line Business Mailing Address:
INNOVAGE LOWRY ATTN: GAYLE WASHINGTON
Provider Business Mailing Address City Name:
DENVER
Provider Business Mailing Address State Name:
CO
Provider Business Mailing Address Postal Code:
80230
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
303-869-4664
Provider Business Mailing Address Fax Number:
303-996-1600

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3551 CHAMBERS RD STE A-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:
80011-1330
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
303-375-0649
Provider Business Practice Location Address Fax Number:
303-375-0986
Provider Enumeration Date:
04/08/2016

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LG0600X , with the licence number:  APN.0991721-NP , 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)

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




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