Healthcare Provider Details

I. General information

NPI: 1457640427
Provider Name (Legal Business Name): TRIBEKA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/30/2011
Last Update Date: 03/30/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1980 S QUEBEC ST SUITE 102
DENVER CO
80231-3239
US

IV. Provider business mailing address

PO BOX 1371
CASTLE ROCK CO
80104-1371
US

V. Phone/Fax

Practice location:
  • Phone: 720-583-7676
  • Fax: 866-678-8525
Mailing address:
  • Phone: 720-583-7676
  • Fax: 866-678-8525

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State

VIII. Authorized Official

Name: MISS ASHANTI U BROWN
Title or Position: CHIEF EXECUTIVE DIRECTOR
Credential:
Phone: 720-583-7676