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General NPI Number Information
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NPI Number | 1881190791
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Entity Type | Organization
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Legal Business Name | REHOBOTH HOME SUPPORT, LLC
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Dates
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Enumeration Date | 04/02/2018
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Last Update Date | 10/22/2021
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Provider Practice Location Address
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Address Line | 12354 E CALEY AVE UNIT 201
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City | CENTENNIAL
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State | CO
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Zip | 80111-6853
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Country | US
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Telephone | 720-524-7820
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Fax | 720-440-9154
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Provider Business Mailing Address
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Address Line | 12354 E CALEY AVE UNIT 201
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City | CENTENNIAL
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State | CO
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Zip | 80111-6853
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Country | US
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Telephone | 720-524-7820
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Fax | 720-440-9154
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Authorized Official
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Title or Position | DIRECTOR
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Name | DAWIT G MEDHIN
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Credential |
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Telephone | 303-885-0183
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 347E00000X
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Taxonomy Name | Transportation Broker
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License Number |
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License Number State | CO
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Taxonomy #2
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Taxonomy Code | 376J00000X
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Taxonomy Name | Homemaker
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License Number |
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License Number State |
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Taxonomy #3
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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 | CO
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