Healthcare Provider Details

I. General information

NPI: 1992998363
Provider Name (Legal Business Name): BOULDER COUNTY ENTERPRISES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/20/2007
Last Update Date: 01/18/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6290 LOOKOUT RD
BOULDER CO
80301-3319
US

IV. Provider business mailing address

6290 LOOKOUT RD
BOULDER CO
80301-3319
US

V. Phone/Fax

Practice location:
  • Phone: 303-266-2789
  • Fax: 303-527-0628
Mailing address:
  • Phone: 720-266-2789
  • Fax: 303-527-0628

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code376J00000X
TaxonomyHomemaker
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number
License Number State

VIII. Authorized Official

Name: MR. ROBERT A LAWHEAD
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 720-266-2789