Healthcare Provider Details

I. General information

NPI: 1821454398
Provider Name (Legal Business Name): ASSURANCE SUPPORT SERVICES AGENCY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/13/2016
Last Update Date: 06/15/2021
Certification Date: 06/15/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11059 E BETHANY DR STE 105
AURORA CO
80014-2617
US

IV. Provider business mailing address

24789 E FLORIDA AVE
AURORA CO
80018-6054
US

V. Phone/Fax

Practice location:
  • Phone: 720-420-9049
  • Fax: 720-368-5299
Mailing address:
  • Phone: 720-420-9049
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number State

VIII. Authorized Official

Name: MISS GORMAH PINKY KOLLEH
Title or Position: OWNER
Credential:
Phone: 215-888-4813