Healthcare Provider Details

I. General information

NPI: 1669107736
Provider Name (Legal Business Name): COLORADO HOME MODIFICATIONS LTD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/21/2022
Last Update Date: 07/21/2022
Certification Date: 07/21/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10255 CARMODY LN
LAKEWOOD CO
80227-2084
US

IV. Provider business mailing address

10255 CARMODY LN
LAKEWOOD CO
80227-2084
US

V. Phone/Fax

Practice location:
  • Phone: 303-229-5724
  • Fax:
Mailing address:
  • Phone: 303-229-5724
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171WH0202X
TaxonomyHome Modifications Contractor
License Number
License Number State

VIII. Authorized Official

Name: GREGORY M STOFAC
Title or Position: SOLE MEMBER
Credential:
Phone: 303-229-5724