Healthcare Provider Details

I. General information

NPI: 1013404490
Provider Name (Legal Business Name): 247 AVARE HEALTHCARE PREMIER LTD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/20/2018
Last Update Date: 09/28/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22401 E UNION CIR
AURORA CO
80015-5540
US

IV. Provider business mailing address

22401 E UNION CIR
AURORA CO
80015-5540
US

V. Phone/Fax

Practice location:
  • Phone: 303-710-5723
  • Fax:
Mailing address:
  • Phone: 303-710-5723
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number04K480
License Number StateCO

VIII. Authorized Official

Name: ARTUR AKHMETOV
Title or Position: ADMINISTRATOR
Credential:
Phone: 303-710-5723