=====================================================
General NPI Number Information
=====================================================
NPI Number | 1730890278
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | HBA FOUNDATION
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/06/2022
-----------------------------------------------------
Last Update Date | 12/06/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 88 INVERNESS CIR E UNIT E104
-----------------------------------------------------
City | ENGLEWOOD
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 80112-5511
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 303-551-6721
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 88 INVERNESS CIR E UNIT E104
-----------------------------------------------------
City | ENGLEWOOD
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 80112-5511
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 303-551-6721
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PROGRAM DIRECTOR
-----------------------------------------------------
Name | MR. BRIAN M JOHNSON
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 303-435-0055
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 171WH0202X
-----------------------------------------------------
Taxonomy Name | Home Modifications Contractor
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------