Healthcare Provider Details

I. General information

NPI: 1467371286
Provider Name (Legal Business Name): VAST REENTRY SERVICES, LTD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/14/2026
Last Update Date: 07/16/2026
Certification Date: 07/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1777 S HARRISON ST
DENVER CO
80210-3925
US

IV. Provider business mailing address

1777 S HARRISON ST
DENVER CO
80210-3925
US

V. Phone/Fax

Practice location:
  • Phone: 720-750-0613
  • Fax:
Mailing address:
  • Phone: 720-750-0613
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State

VIII. Authorized Official

Name: MR. MALIK ASAD AL-MALAKI II
Title or Position: DIRECTOR
Credential: CPS
Phone: 720-750-0613