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General NPI Number Information
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NPI Number | 1831963115
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Entity Type | Organization
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Legal Business Name | ROMANS 12:2 SHNL LLC
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Dates
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Enumeration Date | 11/08/2023
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Last Update Date | 11/08/2023
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Provider Practice Location Address
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Address Line | 3842 RED VALLEY CIR
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City | CASTLE ROCK
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State | CO
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Zip | 80104-3522
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Country | US
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Telephone | 720-205-2505
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Fax |
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Provider Business Mailing Address
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Address Line | 3842 RED VALLEY CIR
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City | CASTLE ROCK
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State | CO
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Zip | 80104-3522
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Country | US
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Telephone | 720-205-2505
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | KRYSTINA EDEN
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Credential | NP
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Telephone | 720-205-2505
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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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 | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number |
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License Number State |
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