Healthcare Provider Details

I. General information

NPI: 1770202046
Provider Name (Legal Business Name): DUST AND PAN
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/22/2022
Last Update Date: 08/22/2022
Certification Date: 08/22/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 BROADWAY STE 1601
DENVER CO
80202-4927
US

IV. Provider business mailing address

1600 BROADWAY STE 1601
DENVER CO
80202-4927
US

V. Phone/Fax

Practice location:
  • Phone: 720-925-1822
  • Fax:
Mailing address:
  • Phone: 720-925-1822
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251G00000X
TaxonomyCommunity Based Hospice Care 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 Code3104A0625X
TaxonomyAssisted Living Facility (Mental Illness)
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code347C00000X
TaxonomyPrivate Vehicle
License Number
License Number State

VIII. Authorized Official

Name: MR. DEVONNE NOEL AUSTIN
Title or Position: OWNER
Credential: MPA, JD
Phone: 720-925-1822