Healthcare Provider Details

I. General information

NPI: 1679002034
Provider Name (Legal Business Name): RUKECHA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/08/2017
Last Update Date: 07/21/2022
Certification Date: 09/28/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1425 S ENSENADA ST
AURORA CO
80017
US

IV. Provider business mailing address

1425 S ENSENADA ST
AURORA CO
80017-5531
US

V. Phone/Fax

Practice location:
  • Phone: 720-272-8496
  • Fax:
Mailing address:
  • Phone: 720-272-8496
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MARTHE IFULU
Title or Position: CEO
Credential:
Phone: 720-272-8496