Healthcare Provider Details

I. General information

NPI: 1568811933
Provider Name (Legal Business Name): F.R.I.E.N.D.S. OF BROOMFIELD, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/07/2016
Last Update Date: 02/14/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11851 SAULSBURY ST
BROOMFIELD CO
80020-2808
US

IV. Provider business mailing address

11851 SAULSBURY ST
BROOMFIELD CO
80020-2808
US

V. Phone/Fax

Practice location:
  • Phone: 303-404-0123
  • Fax:
Mailing address:
  • Phone: 303-404-0123
  • Fax:

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: MS. GINA K COUFAL
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 303-404-0123