Provider Demographics
NPI:1093196198
Name:KIDS WHEELS LLC
Entity Type:Organization
Organization Name:KIDS WHEELS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:PHYLLIS
Authorized Official - Middle Name:
Authorized Official - Last Name:EGGERT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:303-202-2700
Mailing Address - Street 1:1360 S WADSWORTH BLVD STE 102
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80232-5454
Mailing Address - Country:US
Mailing Address - Phone:303-202-2700
Mailing Address - Fax:
Practice Address - Street 1:1360 S WADSWORTH BLVD STE 102
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80232-5454
Practice Address - Country:US
Practice Address - Phone:303-202-2700
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-15
Last Update Date:2015-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO06000608343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
Provider Identifiers
StateIdentifier IDID TypeIssuer
50096OtherPUC
CO06000608Medicaid