Healthcare Provider Details

I. General information

NPI: 1407549504
Provider Name (Legal Business Name): ADVANTAGE TRANSITION AGENCY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/02/2023
Last Update Date: 11/20/2024
Certification Date: 11/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10800 E BETHANY DR STE 105A
AURORA CO
80014-2687
US

IV. Provider business mailing address

10800 E BETHANY DR
AURORA CO
80014-2687
US

V. Phone/Fax

Practice location:
  • Phone: 720-949-4055
  • Fax: 720-367-5755
Mailing address:
  • Phone: 267-444-2011
  • Fax: 720-367-5755

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code320900000X
TaxonomyIntellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code376J00000X
TaxonomyHomemaker
License Number
License Number State

VIII. Authorized Official

Name: MISS KEMAH KOLLEH
Title or Position: OWNER
Credential:
Phone: 720-949-4055