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General NPI Number Information
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NPI Number | 1659014819
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Entity Type | Organization
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Legal Business Name | HOLY HOST HOME AGENCY LLC
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Dates
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Enumeration Date | 04/15/2022
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Last Update Date | 04/15/2022
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Provider Practice Location Address
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Address Line | 4815 LISBON ST
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City | DENVER
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State | CO
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Zip | 80249-7455
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Country | US
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Telephone | 720-492-6027
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Fax |
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Provider Business Mailing Address
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Address Line | 4815 LISBON ST
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City | DENVER
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State | CO
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Zip | 80249-7455
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Country | US
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Telephone | 720-492-6027
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Fax |
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Authorized Official
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Title or Position | DIRECTOR
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Name | BETHLEHEM MERID
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Credential |
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Telephone | 720-492-6027
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 320900000X
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Taxonomy Name | Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
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License Number |
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License Number State |
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