Healthcare Provider Details

I. General information

NPI: 1134726136
Provider Name (Legal Business Name): VENEZIA INNOVATIVE SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/03/2020
Last Update Date: 10/06/2020
Certification Date: 10/06/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16762 E ILIFF AVE
AURORA CO
80013-1135
US

IV. Provider business mailing address

16762 E ILIFF AVE
AURORA CO
80013-1135
US

V. Phone/Fax

Practice location:
  • Phone: 720-297-1002
  • Fax:
Mailing address:
  • Phone: 720-297-1002
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code373H00000X
TaxonomyDay Training/Habilitation Specialist
License Number
License Number State

VIII. Authorized Official

Name: LOVE DZAKPASU
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 720-297-1002