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General NPI Number Information
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NPI Number | 1417481144
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Entity Type | Organization
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Legal Business Name | ANDIRA INC
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Dates
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Enumeration Date | 04/19/2017
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Last Update Date | 04/19/2017
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Provider Practice Location Address
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Address Line | 6666 S PINEY CREEK CIR
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City | CENTENNIAL
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State | CO
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Zip | 80016-1108
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Country | US
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Telephone | 303-797-9110
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Fax | 720-204-2652
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Provider Business Mailing Address
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Address Line | PO BOX 631053
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City | HIGHLANDS RANCH
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State | CO
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Zip | 80163-1053
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Country | US
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Telephone | 303-797-9110
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Fax | 720-204-2652
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Authorized Official
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Title or Position | CEO
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Name | ABIMBOLA OMITERU
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Credential |
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Telephone | 303-520-3009
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 310400000X
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Taxonomy Name | Assisted Living Facility
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License Number | 23I538
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License Number State | CO
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