Healthcare Provider Details

I. General information

NPI: 1578475141
Provider Name (Legal Business Name): KUBROM REDDAI HAILE
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/19/2026
Last Update Date: 09/19/2026
Certification Date: 09/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6257 S KILLARNEY CT
CENTENNIAL CO
80016-3808
US

IV. Provider business mailing address

6257 S KILLARNEY CT
CENTENNIAL CO
80016-3808
US

V. Phone/Fax

Practice location:
  • Phone: 720-519-2525
  • Fax:
Mailing address:
  • Phone: 720-519-2525
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: