=====================================================
General NPI Number Information
=====================================================
NPI Number | 1447114855
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ALPINE SQUARE LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/10/2025
-----------------------------------------------------
Last Update Date | 12/10/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 6407 WILLOW BROOM TRL
-----------------------------------------------------
City | LITTLETON
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 80125-9078
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 708-979-3601
-----------------------------------------------------
Fax | 720-538-0539
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6407 WILLOW BROOM TRL
-----------------------------------------------------
City | LITTLETON
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 80125-9078
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 708-979-3601
-----------------------------------------------------
Fax | 720-538-0539
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MANAGING MEMBER
-----------------------------------------------------
Name | MARY L JUDY
-----------------------------------------------------
Credential | WIP-C
-----------------------------------------------------
Telephone | 708-979-3601
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251B00000X
-----------------------------------------------------
Taxonomy Name | Case Management Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------