Healthcare Provider Details

I. General information

NPI: 1487368601
Provider Name (Legal Business Name): KOTILLO BLESSING CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/11/2023
Last Update Date: 01/11/2023
Certification Date: 01/11/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4318 CEYLON CT
DENVER CO
80249-6540
US

IV. Provider business mailing address

4318 CEYLON CT
DENVER CO
80249-6540
US

V. Phone/Fax

Practice location:
  • Phone: 720-327-8315
  • Fax:
Mailing address:
  • Phone: 720-327-8315
  • 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 Code320900000X
TaxonomyIntellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name: MACHANDOQUE KOTILO
Title or Position: OWNER
Credential:
Phone: 720-327-8315