Healthcare Provider Details

I. General information

NPI: 1457941981
Provider Name (Legal Business Name): ABLELIGHT INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/19/2021
Last Update Date: 06/09/2022
Certification Date: 06/09/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6645 S SHERMAN ST
CENTENNIAL CO
80121-2351
US

IV. Provider business mailing address

600 HOFFMANN DR
WATERTOWN WI
53094-6223
US

V. Phone/Fax

Practice location:
  • Phone: 303-347-2118
  • Fax:
Mailing address:
  • Phone: 920-261-3050
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code315P00000X
TaxonomyIntellectual Disabilities Intermediate Care Facility
License Number
License Number State

VIII. Authorized Official

Name: MICHAEL MINNING
Title or Position: DIRECTOR OF TREASURY
Credential:
Phone: 920-206-4459