Healthcare Provider Details

I. General information

NPI: 1447114855
Provider Name (Legal Business Name): ALPINE SQUARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/10/2025
Last Update Date: 12/10/2025
Certification Date: 12/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6407 WILLOW BROOM TRL
LITTLETON CO
80125-9078
US

IV. Provider business mailing address

6407 WILLOW BROOM TRL
LITTLETON CO
80125-9078
US

V. Phone/Fax

Practice location:
  • Phone: 708-979-3601
  • Fax: 720-538-0539
Mailing address:
  • Phone: 708-979-3601
  • Fax: 720-538-0539

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: MARY L JUDY
Title or Position: MANAGING MEMBER
Credential: WIP-C
Phone: 708-979-3601