MEDICARE: RANDCORP, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	171WH0202X	Home Modifications Contractor

General Provider Information

NPI Number	:	1376223883
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RANDCORP, INC.

Provider Business Mailing Address
First Line	:	2505 WALNUT ST STE 301
Second Line	:
City	:	BOULDER
State	:	CO
Zip	:	80302-5744
Country	:	US
Telephone Number	:	303-507-2942
Fax Number	:	303-415-9760

Provider Business Practice Location Address
First Line	:	2505 WALNUT ST STE 301
Second Line	:
City	:	BOULDER
State	:	CO
Zip	:	80302-5744
Country	:	US
Telephone Number	:	303-507-2942
Fax Number	:	303-415-9760

Authorized Official
Title or Position	:	CORPORATE SECRETARY
Name	:	MR. ALI YOUSEF
Credential	:
Telephone Number	:	303-507-2942

Provider Enumeration Date	:	07/19/2023
Last Update Date	:	07/19/2023

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Directions to “RANDCORP, INC. ” Practice Location

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