Healthcare Provider Details

I. General information

NPI: 1619547171
Provider Name (Legal Business Name): FRANKLIN AVENUE HEALTHCARE INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/28/2021
Last Update Date: 06/28/2021
Certification Date: 06/28/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

855 FRANKLIN AVE
BERTHOUD CO
80513-1158
US

IV. Provider business mailing address

855 FRANKLIN AVE
BERTHOUD CO
80513-1158
US

V. Phone/Fax

Practice location:
  • Phone: 970-532-2683
  • Fax: 970-532-0602
Mailing address:
  • Phone: 970-532-2683
  • Fax: 970-532-0602

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number
License Number State

VIII. Authorized Official

Name: SOON BURNAM
Title or Position: TREASURER
Credential:
Phone: 949-540-1249