Provider Demographics
NPI:1093363475
Name:NIMADIA LLC
Entity Type:Organization
Organization Name:NIMADIA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:NICK
Authorized Official - Middle Name:
Authorized Official - Last Name:DIACK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:720-900-5501
Mailing Address - Street 1:630 S DAHLIA CIR APT N-304
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80246-3319
Mailing Address - Country:US
Mailing Address - Phone:720-339-8801
Mailing Address - Fax:
Practice Address - Street 1:1633 FILLMORE ST STE 114
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80206-1556
Practice Address - Country:US
Practice Address - Phone:720-900-5501
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-08-29
Last Update Date:2019-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty