Healthcare Provider Details

I. General information

NPI: 1477386324
Provider Name (Legal Business Name): LOLA ENTERPRISE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/24/2024
Last Update Date: 08/24/2024
Certification Date: 08/24/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5561 W FAIR DR
LITTLETON CO
80123-3714
US

IV. Provider business mailing address

5561 W FAIR DR
LITTLETON CO
80123-3714
US

V. Phone/Fax

Practice location:
  • Phone: 720-364-5517
  • Fax:
Mailing address:
  • Phone: 720-364-5517
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QD1600X
TaxonomyDevelopmental Disabilities Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: APRIL A MERRILL
Title or Position: OWNER
Credential:
Phone: 720-364-5517