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General NPI Number Information
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NPI Number | 1831565019
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Entity Type | Organization
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Legal Business Name | STEP UP SUPPORT SERVICES, LLC
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Dates
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Enumeration Date | 08/11/2015
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Last Update Date | 07/05/2016
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Provider Practice Location Address
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Address Line | 5473 ODESSA ST
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City | DENVER
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State | CO
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Zip | 80249-8393
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Country | US
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Telephone | 303-956-8292
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 390611
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City | DENVER
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State | CO
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Zip | 80239-1611
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Country | US
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Telephone | 303-956-8292
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Fax |
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | MR. JONATHAN P JIMENEZ
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Credential |
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Telephone | 303-956-8292
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 385H00000X
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Taxonomy Name | Respite Care
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 251C00000X
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Taxonomy Name | Developmentally Disabled Services Day Training Agency
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License Number |
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License Number State |
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