Healthcare Provider Details

I. General information

NPI: 1477105765
Provider Name (Legal Business Name): DRAGONFLY SUPPORTIVE SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/16/2019
Last Update Date: 09/08/2022
Certification Date: 09/08/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2563 S COUNTY ROAD 193
BYERS CO
80103-9409
US

IV. Provider business mailing address

2563 S COUNTY ROAD 193
BYERS CO
80103-9409
US

V. Phone/Fax

Practice location:
  • Phone: 303-819-9133
  • Fax:
Mailing address:
  • Phone: 303-819-9133
  • 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 Code320600000X
TaxonomyIntellectual and/or Developmental Disabilities Residential Treatment Facility
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code376J00000X
TaxonomyHomemaker
License Number
License Number State

VIII. Authorized Official

Name: DORIS AVILA-HARDEE
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 303-819-9133