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General NPI Number Information
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NPI Number | 1902255334
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Entity Type | Organization
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Legal Business Name | ACTIVE COMMUNITY ACCESS LLC
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Dates
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Enumeration Date | 06/07/2016
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Last Update Date | 06/07/2016
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Provider Practice Location Address
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Address Line | 6841 S YOSEMITE ST
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City | CENTENNIAL
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State | CO
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Zip | 80112-1434
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Country | US
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Telephone | 720-988-9827
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 24327
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City | DENVER
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State | CO
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Zip | 80224-0327
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Country | US
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Telephone | 720-988-9827
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Fax |
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Authorized Official
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Title or Position | DIRECTOR
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Name | MARY BRAUN
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Credential | MS
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Telephone | 720-988-9827
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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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