Healthcare Provider Details

I. General information

NPI: 1407675242
Provider Name (Legal Business Name): GAIA CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/08/2024
Last Update Date: 10/08/2024
Certification Date: 10/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1001 E 62ND AVE UNIT 867
DENVER CO
80216-1170
US

IV. Provider business mailing address

4403 GARNET WAY
LONGMONT CO
80504-5384
US

V. Phone/Fax

Practice location:
  • Phone: 720-624-6513
  • Fax:
Mailing address:
  • Phone: 720-624-6513
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code385HR2060X
TaxonomyChild Intellectual and/or Developmental Disabilities Respite Care
License Number
License Number State

VIII. Authorized Official

Name: DEVON KADETH GATES
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 720-624-6513