Healthcare Provider Details

I. General information

NPI: 1184083404
Provider Name (Legal Business Name): JERRY ARAGON CONSTRUCTION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/15/2016
Last Update Date: 02/24/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2551 W 52ND AVE
DENVER CO
80221-1645
US

IV. Provider business mailing address

2551 W 52ND AVE
DENVER CO
80221-1645
US

V. Phone/Fax

Practice location:
  • Phone: 303-480-0101
  • Fax: 303-480-0263
Mailing address:
  • Phone: 303-480-0101
  • Fax: 303-480-0263

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171WH0202X
TaxonomyHome Modifications Contractor
License Number9634
License Number StateCO

VIII. Authorized Official

Name: MR. JERRY ARAGON
Title or Position: OWNER
Credential: GEN CONTRACTOR
Phone: 303-480-0101