Healthcare Provider Details

I. General information

NPI: 1700419488
Provider Name (Legal Business Name): HANNA CARES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/20/2020
Last Update Date: 12/29/2020
Certification Date: 12/29/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6550 S IDER ST
AURORA CO
80016-1251
US

IV. Provider business mailing address

6550 S IDER ST
AURORA CO
80016-1251
US

V. Phone/Fax

Practice location:
  • Phone: 720-601-1645
  • Fax:
Mailing address:
  • Phone: 720-579-6204
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code320600000X
TaxonomyIntellectual and/or Developmental Disabilities Residential Treatment Facility
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number
License Number State

VIII. Authorized Official

Name: ROY GULTOM
Title or Position: CO-OWNER
Credential:
Phone: 720-579-6204