Healthcare Provider Details

I. General information

NPI: 1215169107
Provider Name (Legal Business Name): M & M PLUMBING AND HOME MODIFICATION, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/11/2009
Last Update Date: 08/11/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17531 E DICKENSON PL
AURORA CO
80013-4179
US

IV. Provider business mailing address

17531 E DICKENSON PL
AURORA CO
80013-4179
US

V. Phone/Fax

Practice location:
  • Phone: 303-481-8090
  • Fax: 303-481-8090
Mailing address:
  • Phone: 303-481-8090
  • Fax: 303-481-8090

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171WH0202X
TaxonomyHome Modifications Contractor
License Number163734
License Number StateCO

VIII. Authorized Official

Name: MR. MIKE ELBAUM
Title or Position: OWNER
Credential:
Phone: 303-481-8090