MEDICARE: JACK OF ALL TRADES LLC CO

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	2016105374600CL	CO

General Provider Information

NPI Number	:	1447619457
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JACK OF ALL TRADES LLC CO

Provider Business Mailing Address
First Line	:	13057 E COLORADO AVE
Second Line	:
City	:	AURORA
State	:	CO
Zip	:	80012-5322
Country	:	US
Telephone Number	:	720-297-7542
Fax Number	:	303-745-3393

Provider Business Practice Location Address
First Line	:	13057 E COLORADO AVE
Second Line	:
City	:	AURORA
State	:	CO
Zip	:	80012-5322
Country	:	US
Telephone Number	:	720-297-7542
Fax Number	:	303-745-3393

Authorized Official
Title or Position	:	PRESIDENT
Name	:	TAMARA BORUKHOV
Credential	:
Telephone Number	:	720-297-7542

Provider Enumeration Date	:	02/18/2016
Last Update Date	:	02/16/2021

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Directions to “JACK OF ALL TRADES LLC CO ” Practice Location

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